Abstract 14691: Chronic Kidney Disease is Associated with Abnormal Cardiac Mechanics and Adverse Outcomes in Patients with Heart Failure with Preserved Ejection Fraction
Introduction: Chronic kidney disease (CKD) and heart failure with preserved ejection fraction (HFpEF) are becoming more prevalent in the population and often coincide. CKD has been associated with worse outcomes in HFpEF patients. However, echocardiographic parameters associated with CKD, particularly indices of cardiac mechanics, have not been well studied. We hypothesized that lower GFR is associated with worse cardiac mechanics in HFpEF independent of cardiac structural parameters and indices of volume overload.
Methods: We prospectively studied 299 patients with HFpEF enrolled in the Northwestern University HFpEF Program. Estimated GFR (eGFR) was calculated using the creatinine-based CKD-Epi equation and grouped into CKD stages. Comprehensive echo, including tissue Doppler and speckle tracking imaging, was used to evaluate indices of cardiac mechanics. We used multivariable-adjusted linear and Cox regression analyses to determine the association between CKD and echo parameters and outcomes, respectively.
Results: Mean age was 65±12y, 64% were female, and 38% were African American. Of 299 participants, 145 (48%) had CKD, defined as eGFR < 60 ml/min/1.73m2. Those with CKD had significantly worse indices of cardiac mechanics compared to those without CKD (Figure). In particular, those with CKD had worse global longitudinal strain (GLS) and left atrial strain even after adjusting for age, volume status (E/e’, RA pressure), LV mass, and comorbidities (P<0.05). For example, after adjusting for age, HTN, CAD, diabetes, obesity, RA pressure, and E/e', for each 1-SD decrease in eGFR, absolute GLS was 0.6 %-units lower (95% CI 0.1-1.1 %-units lower, P=0.022), indicating worse longitudinal mechanics. CKD stage was associated with adverse outcomes in HFpEF (Log-rank P=0.002, Figure).
Conclusion: In the setting of HFpEF, CKD is independently associated with worse cardiac mechanics, which may explain why HFpEF patients with CKD have worse outcomes.
Author Disclosures: E.D. Unger: None. R. Dubin: None. R. Deo: None. V. Daruwalla: None. J. Friedman: None. C. Medina: None. L. Beussink: None. B. Freed: None. S.J. Shah: None.
- © 2014 by American Heart Association, Inc.