Abstract 12148: Renal Dysfunction is Independently Associated With Impaired Diastolic Function in Patients With Acute Myocardial Infarction
Background: Renal dysfunction in patients with acute myocardial infarction (MI) is an important predictor of short- and long term outcome. Cardiac abnormalities dominated by left ventricular (LV ) hypertrophy are common in patients with chronic renal dysfunction. However, limited data exists on the association between LV systolic- and diastolic function assessed by comprehensive echocardiography and renal dysfunction in contemporary unselected patients with acute MI.
Methods and results: We prospectively included 1054 patients with acute MI (mean age 63 years, 73% male) and performed echocardiographic assessment of systolic and diastolic function within 48 hours of admission. Estimated glomerular filtration rate (eGFR) was significantly associated with LV mass, LV ejection fraction (LVEF), LV global strain (GLS) and E/e’ ratio. After multivariable adjustment, E/e’ ratio (p=0.0096) remained the only echocardiographic measure independently associated with decreasing eGFR. During follow-up a total of 113 patients (10.7%) patients experienced the composite endpoint of all-cause mortality or hospitalization for heart failure. An eGFR<60 mL/min/1.73m2 was significantly associated with outcome (HR: 1.71; 95%CI: 1.12-2.62, p=0.0131) after adjustment for age, diabetes, hypertension, Killip Class >1, Multivessel disease and troponin. The prognostic impact of an eGFR≤60 mL/min/1.73m2 was only modestly altered by addition of LV mass or E/e’ ratio whereas addition of LVEF or GLS attenuated its importance considerably.
Conclusion: Renal dysfunction in patients with acute MI is independently associated with echocardiographic evidence of increased LV filling pressure. However, the prognostic importance of renal dysfunction is attenuated to a greater degree by LV longitudinal systolic function.
- © 2013 by American Heart Association, Inc.