Abstract
Chronic-phase worsening renal function (WRF) in patients with acute myocardial infarction (AMI) has been associated with poor prognosis. However, there is no consensus on either the method of prevention or the cause. The aim of this study was to determine factors predictive of chronic-phase WRF from the viewpoint of circulatory dynamics response to exercise during hospitalization of AMI patients without renal dysfunction on admission. We studied 186 consecutively AMI patients who underwent the 200-m walk test. Chronic-phase WRF was defined as a 20% decrease in estimated glomerular filtration rate (eGFR) from baseline to 8–10 months after AMI onset. Heart rate (HR) and systolic blood pressure recorded during the 200-m walk test were evaluated as circulatory dynamics responses. In total, 94 patients were enrolled. Multiple linear regression analysis showed that ΔHR (peak-rest) associated significantly with ΔeGFR (β = 0.427, p = 0.018). The receiver operating characteristic curve of ΔHR to predict chronic-phase WRF showed an area under the curve of 0.77, with a cut-off value of 22.0 bpm having a 95% sensitivity and 55% specificity. Among circulatory dynamics responses during exercise in the acute phase after AMI, ΔHR was an independent predictor of chronic-phase WRF.
Highlights
Chronic-phase worsening renal function (WRF) in patients with acute myocardial infarction (AMI) has been associated with major adverse cardiac events and an incidence reported to range from 6.4–33% [1,2,3,4,5,6]
Patients in the chronic-phase WRF group included more females than males and had longer pain to balloon time and higher BUN/CRE and BNP values than those in the non-chronic-phase WRF group. estimated glomerular filtration rate (eGFR) was significantly higher in the patients in the chronic-phase WRF group than in those in the Non-chronic-phase WRF group at admission
This group showed a decrease in eGFR of 24.4 mL/min/1.73 m2 after 8–10 months, whereas eGFR in the non-chronic-phase WRF group decreased only by 4.1 mL/min/1.73 m2
Summary
Chronic-phase worsening renal function (WRF) in patients with acute myocardial infarction (AMI) has been associated with major adverse cardiac events and an incidence reported to range from 6.4–33% [1,2,3,4,5,6]. A few studies [1,2,3,4,5,6] have reported various predictive factors of chronic-phase WRF, but there is no consistency on these factors. The presumed causes are differences in the study cohorts, the definition of WRF, and variations in clinical practice between institutions. Previous reports showed that predictors of chronic-phase WRF are associated with pathological conditions and treatment during hospitalization. Public Health 2019, 16, 4785; doi:10.3390/ijerph16234785 www.mdpi.com/journal/ijerph
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