Brief Article
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World J Cardiol. Jan 26, 2010; 2(1): 13-18
Published online Jan 26, 2010. doi: 10.4330/wjc.v2.i1.13
Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction
Vinod Jorapur, Gervasio A Lamas, Zygmunt P Sadowski, Harmony R Reynolds, Antonio C Carvalho, Christopher E Buller, James M Rankin, Jean Renkin, Philippe Gabriel Steg, Harvey D White, Carlos Vozzi, Eduardo Balcells, Michael Ragosta, C Edwin Martin, Vankeepuram S Srinivas, William W Wharton III, Staci Abramsky, Ana C Mon, Shari S Kronsberg, Judith S Hochman
Vinod Jorapur, Gervasio A Lamas, Ana C Mon, Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL 33140, United States
Zygmunt P Sadowski, II Ischemic Heart Disease Department, National Institute of Cardiology, Warsaw, 04628, Poland
Harmony R Reynolds, Staci Abramsky, Judith S Hochman, Leon Charney Division of Cardiology, New York University School of Medicine, NY 10016, United States
Antonio C Carvalho, Cardiology Division - Hospital Sao Paulo, Federal University of Sao Paulo, Sao Paulo, 04080004, Brazil
Christopher E Buller, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, L8L 2X2, Canada
James M Rankin, Department of Cardiovascular Medicine, Royal Perth Hospital, Perth 6000, Australia
Jean Renkin, Department of Cardiology, UCL St Luc University Hospital, Brussels 1200, Belgium
Philippe Gabriel Steg, INSERM U-698, Department of Cardiology, Hopital Bichat, AP-HP, and Université Paris 7, Paris 75877, France
Harvey D White, Cardiology Department, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland 1142, New Zealand
Carlos Vozzi, Interventional Cardiology, Instituto de Intervenciones Cardiovasculares S.A., Rosario 2000, Argentina
Eduardo Balcells, Cardiovascular Associates, Wellmont Holston Valley Medical Center, Kingsport, TN 37660, United States
Michael Ragosta, Cardiovascular Division, University of Virginia, Charlottesville, VA 22908, United States
C Edwin Martin, Department of Medicine - Division of Cardiology, York Hospital, York, PA 17405, United States
Vankeepuram S Srinivas, Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10468, United States
William W Wharton III, Research Department, Asheville Cardiology Associates, P.A., Asheville, NC 28803, United States
Shari S Kronsberg, Maryland Medical Research Institute, Baltimore, MD 21210, United States
Author contributions: The authors had full access to the data and take responsibility for its integrity; all authors have read and agree to the manuscript as written.
Supported by Award Numbers U01 HL062509 and U01 HL062511 from the National Heart, Lung, And Blood Institute
Correspondence to: Judith S Hochman, MD, Leon Charney Division of Cardiology, New York University School of Medicine, NY 10016, United States. judith.hochman@nyumc.org
Telephone: +1-212-2636927 Fax: +1-212-2637129
Received: January 16, 2010
Revised: January 24, 2010
Accepted: January 25, 2010
Published online: January 26, 2010
Abstract

AIM: To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF).

METHODS: Patients with occluded infarct-related arteries (IRAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFR). Rates of early post-MI HF were compared among eGFR groups. Logistic regression was used to explore independent predictors of HF.

RESULTS: Reduced eGFR was present in 71.1% of 2160 patients, with significant renal impairment (eGFR < 60 mL/min every 1.73 m2) in 14.8%. The prevalence of HF was higher with worsening renal function: 15.5%, 17.8% and 29.4% in patients with CKD stages 1, 2 and 3 or 4, respectively (P < 0.0001), despite a small absolute difference in mean EF across eGFR groups: 48.2 ± 10.0, 47.9 ± 11.3 and 46.2 ± 12.1, respectively (P = 0.02). The prevalence of HF was again higher with worsening renal function among patients with preserved EF: 10.1%, 13.6% and 23.6% (P < 0.0001), but this relationship was not significant among patients with depressed EF: 27.1%, 26.2% and 37.9% (P = 0.071). Moreover, eGFR was an independent correlate of HF in patients with preserved EF (P = 0.003) but not in patients with depressed EF (P = 0.181).

CONCLUSION: A significant proportion of post-MI patients with occluded IRAs have impaired renal function. Impaired renal function was associated with an increased rate of early post-MI HF, the association being strongest in patients with preserved EF. These findings have implications for management of peri-infarct HF.

Keywords: Heart failure; Myocardial infarction; Kidney disease