Abstract 5885: Impacts of Renal Insufficiency on the Prevalence of Heart Failure With Preserved Ejection Fraction in Hypertensive Patients
Renal insufficiency is a predictor of hospitalization for heart failure in hypertensive patients. However, the onset of heart failure in patients with kidney diseases is principally attributed to left ventricular systolic dysfunction induced by myocardial infarction or long-term hypertension, and the effects of renal insufficiency on the prevalence of symptomatic heart failure stage without systolic dysfunction remain unclear. This study aimed to assess the effects of renal insufficiency on the prevalence of heart failure with preserved ejection fraction. Out of 650 hypertensive outpatients with ejection fraction≥50%, 191 patients met the Framingham heart failure criteria. The multiple logistic regression analysis revealed that obese, female, estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2 and a ratio of transmitral E velocity to early diastolic mitral annular velocity (E/E′) >15 were independent predictors of the prevalence of heart failure (Table⇓). To assess the effect of the renal insufficiency, the patients were divided into three groups as follow; CKD-A: eGFR≥75 (n=158), CKD-B: 60≤eGFR<75 (n=207), CKD-C: eGFR<60ml/min/1.73m2 (n=285). The patients in CKD-B group represented higher E/E′ ratio and lower E′ velocity than those in CKD-A group. These indices were not different between the patients in CKD-B and CKD-C group. Hemoglobin concentration was significantly decreased and brachial-ankle pulse wave velocity was significantly elevated in the patients in CKD-C group compared to the other groups. Left ventricular diastolic dysfunction and renal insufficiency are independent risk factors for the prevalence of heart failure with preserved ejection fraction in hypertensive patients. Renal insufficiency exerts its effects through the modulation of extracardiac factors such as anemia and arterial stiffening rather than through the promotion of diastolic dysfunction.