Abstract 3221: Cardiorenal Syndrome in Patients with Complex Congenital Heart Disease
Background. Renal dysfunction is common in patients with heart failure and is related to adverse outcomes. The prevalence of renal dysfunction in patients with complex congenital heart disease with systemic ventricular dysfunction is unknown.
Objectives. The primary objective of the study was to examine the prevalence of renal failure in this population. The secondary objective was to determine the relationship between renal dysfunction and late outcomes.
Methods. Two-hundred and one adults with single or systemic right ventricles and systemic ventricular dysfunction (ejection fraction<50%) were included. Systemic ventricular function was assessed using magnetic resonance imaging (MRI, n=91), radionuclide angiograms (RNA, n=80) or echocardiography (n=30). Creatinine clearance (CrCl) was calculated using the Cockroft-Gault equation.
Results. The mean age of the patients was 33.5 +/−8.6 years (56.7% males). The systemic ventricular ejection fraction was 36.8+/−11.2%. Significant renal dysfunction was defined as a CrCl<60ml/min, and was documented in 36% of patients. Compared to asymptomatic patients, symptomatic patients (NYHA class >1) had significantly lower CrCl (48.2 +/− 21.3 ml/min versus 79.8 +/− 20.9 ml/min, P<0.0001) and higher blood urea nitrogen/creatinine ratio (0.56+/−0.1 versus 0.07 +/−0.03, P<0.0001). Compared to patients with mild renal dysfunction (CrCl>60 ml/min), those patients with moderate or severe renal dysfunction (CrCl>60 ml/min) had a lower systemic ventricular ejection fraction with MRI/RNA (39.4+/−10.4% vs. 32.0+/−11.4%, p<0.0001). Twenty-one patients died; 11 from cardiorenal failure, and 8 from heart failure alone; 1 patient died of endocarditis with multi-organ failure, and 1 patient died from intra-cerebral hemorrhage. Mortality was higher in patients with renal dysfunction compared to those without (23.6% vs. 2.4%, P<0.0001).
Conclusions. Renal dysfunction is common among patients with complex congenital heart disease and systemic right or single ventricular dysfunction. Renal dysfunction is associated with increased mortality. Clinicians should be aware of this common problem, and early diagnosis, prevention, and treatment should be sought.