Abstract
Background: In patients with heart failure with preserved ejection fraction (HFpEF), worse kidney function is associated with worse overall cardiac mechanics. However, the direct relationship between right ventricular function and kidney function is unclear. Right ventricular stroke work index(RVSWI) is a parameter of right ventricular function. Increased RVSWI indicates higher right ventricular workload. There has been only a single study showing the association between increased RVSWI and increased creatinine in HFpEF. The aim of our study was to determine the relationship between RVSWI and glomerular filtration rate (GFR) in patients with HFpEF. Methods: This was a single center study including patients with HFPEF (left ventricular ejection fraction more than 50%) underwent right heart catheterization between January 2010 and April 2016. Patients with moderate or severe valvular heart disease, end-stage renal disease, prosthetic valve or organ transplant were excluded. A retrospective chart review for demographic data, risk factors, right heart catheterization parameters and laboratory results was done. RVSWI(normal value 8–12 g/m/beat/m2) was calculated using the formula, RVSWI = 0.0136x Stroke volume index x (Mean pulmonary artery pressure-mean right atrial pressure). GFR was calculated using MDRD study equation. Linear regression analysis was done to study the correlation between RVSWI and GFR. Multivariable linear regression analysis was also performed to adjust for potential confounders. Results: A total of 130 patients were included in the study. The patients were predominantly female (n = 88, 66%) and African American (n = 83, 64%). Mean age was 68 ± 12 years; 111 (85%) patients had hypertension, 85(65%) had diabetes mellitus, and 28(22%) were smokers. Mean GFR was 61 ± 33 ml/min/1.73 m2. Mean RVSWI was 11 ± 6 g/m/beat/m2. Linear regression analysis showed that there was a significant inverse relationship between RVSWI and GFR (Beta = -1.32, P = .007). After adjusting for confounders including age, sex, race, hypertension, diabetes mellitus, smoking, and history of coronary artery disease, the association remained significant (Beta = −1.12, P = .024, Table 1). Conclusion: Increased right ventricular stroke work index, which reflects the RV adaptation to increased afterload, is associated with worse renal function in patients with heart failure with preserved ejection fraction. Further prospective studies are needed to better understand this association and establish causal relationship.Table 1multivariable linear regression analysisVariablesBeta95% CI of BetaP-valueRVSWI−1.12−2.08 to −0.15.024Age−0.22−0.75 to 0.30.402Race−3.09−8.27 to 2.10.241Hypertension−9.76−26.65 to 7.13.255Hyperlipidemia16.854.36−2.93.009Diabetes Mellitus−5.29−17.83 to 7.26.406Smoking−0.97−15.48 to 13.54.895Sex15.143.30–26.97.013History of coronary artery disease−13.05−24.57 to −1.53.027 Open table in a new tab
Published Version (Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have