Abstract 13934: Echocardiographic Predictors of Change in Renal Function With Intravenous Diuresis for Decompensated Heart Failure

Abstract

Title: Echocardiographic Predictors of Change in Renal Function with Intravenous Diuresis for Decompensated Heart Failure Background: Worsening or improved renal function occurs in a significant proportion of patients with decompensated heart failure who receive intravenous diuretic therapy. The direction of change in renal function has been difficult to predict with current biochemical, physical exam and imaging assessments. Hypothesis: We proposed the following hypotheses: (1) Patients with right ventricular (RV) dilation and systolic dysfunction would be more likely to experience improved renal function (IRF) with diuresis compared to those with normal RV size and function; (2) Patients with heart failure and a preserved left ventricular ejection fraction (LVEF) would be more likely to experience worsening renal function (WRF) with diuresis than those with a reduced LVEF (≤40%). Methods: Retrospective review of 363 patients admitted to a single center from January, 2011 to November, 2014 for decompensated heart failure who underwent intravenous diuresis and transthoracic echocardiography. Data regarding chamber quantification, right and left ventricular systolic function, valvular lesions and diastolic function were collected. Change in renal function was determined using validated GFR estimates based on serum creatinine. Results: Within our study population, 36.4% of patient experienced a decrease in eGFR by at least 10%, 34.7% had stable renal function and 28.9 had an improvement in eGFR by at least 10%. Patients with WRF were more likely to have a preserved LVEF (81/132; 61%) compared to those with stable (59/126, 47%) or improved (47/105, 45%) renal function (p-value 0.015). Patients with IRF were more likely to have a dilated, hypokinetic RV (p-value 0.008). Left atrial size, left ventricular internal diastolic dimension and diastolic dysfunction did not significantly predict change in renal function. Conclusions: Patients with WRF during diuresis for decompensated heart failure are more likely to have a preserved LVEF than those with stable or improved renal function. Those with IRF are significantly more likely to have a dilated, hypokinetic RV.