Abstract 5120: Cardiac Sympathetic Nerve Activity is Associated With the Progression of Cardiorenal Syndrome in Patients With Chronic Heart Failure: 10-Year Follow up Study

Abstract

Background : Chronic heart failure (CHF) and renal dysfunction (RD) frequently coexist. Cardiac sympathetic nerve activity (CSNA) influences the clinical outcomes in CHF patients (pts), but there is no information available on the relation between CSNA and RD in CHF pts, so-called cardiorenal syndrome (CRS). Methods : We studied 101 CHF patients with left ventricular ejection fraction (LVEF) < 40%. At the entry, I-123 MIBG imaging was performed, and washout rate (WR) was calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. Every year, estimated Glomerular Filtration Rate (GFR) by the MDRD equation was obtained in each patient. Results : GFR at the entry was significantly lower in pts with (n=49) than without abnormal WR (n=52) (more than 27%: the mean control WR +2SD) (59±18 vs 67±19 ml/min/1.73m 2 , p=0.029). With a mean follow-up of 7.3±3.5 yrs, GFR decreased from 64±19 to 50±21 ml/min/1.73m 2 , the median value of GFR depression rate (GFRdep) was 3.5%/year, and 31 of 101 pts died of cardiac death. GFRdep was also significantly greater in pts with than without abnormal WR (8.2 vs 2.5%/year, p<0.01). There were no significant differences in gender, age, NYHA class, LVEF, or the content of anti-heart failure therapy between pts with and without WR≥27%. Cardiac death was significantly more frequently observed in pts with than without GFRdep≥3.5%/year (44 vs 16%, p<0.01). The odds ratio of greater GFRdep for cardiac death was 3.8 (95%CI 1.7 to 8.5). Conclusion: In CHF pts, CSNA would be associated with the progression of RD. Furthermore, progression of RD had poor clinical outcome. Thus, CSNA might play an important role in the progression of CRS in CHF pts.