Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction

Table 1 Baseline clinical characteristics by eGFR group (n = 2160) (mean ± SD)

	eGFR≥90 (n = 624)	eGFR 60-89 (n = 1216)	eGFR 15-59 (n = 320)	P value
eGFR mL/min every 1.73 m2	106.0 ± 16.6	75.5 ± 8.1	50.4 ± 7.7	< 0.0001
Age (yr)	54.2 ± 9.7	58.7 ± 10.5	67.2 ± 9.6	< 0.0001
Female (%)	14.6	20.3	43.4	< 0.0001
Diabetes (%)	20.4	18.3	30.0	0.009
Hypertension (%)	39.3	48.4	69.1	< 0.0001
Hyperlipidemia (%)	50.6	51.7	55.5	0.19
Family history of CAD (%)	42.6	40.8	32.8	0.01
Current smoker (%)	51.9	36.9	22.5	< 0.0001
Prior MI (%)	9.5	12.2	10.9	0.28
Thrombolytic use during initial 24 h of index MI (%)	16.5	20.2	20.3	0.09
Troponin I divided by ULN (ng/mL) (n = 1186)	125.0 ± 213.9	186.3 ± 443.8	231.8 ± 516.6	0.01
Troponin T divided by ULN (ng/mL) (n = 281)	46.0 ± 73.4	69.6 ± 190.4	24.1 ± 28.3	0.2
Days from index MI to randomization	10.1 ± 7.4	11.2 ± 7.8	11.6 ± 7.6	0.004
BMI (kg/m2)	28.4 ± 5.1	28.6 ± 4.9	28.5 ± 5.3	0.77
Heart rate (beats/min)	72.1 ± 11.5	71.4 ± 11.9	72.7 ± 12.7	0.13
Systolic BP (mmHg)	119.4 ± 17.4	120.7 ± 17.7	123.9 ± 19.7	0.001
Diastolic BP (mmHg)	72.6 ± 11.1	72.3 ± 11.4	71.8 ± 11.6	0.63
Discharge medications (%)
Aspirin	97.0	95.9	92.5	0.003
Ticlopidine or clopidogrel	73.6	73.2	70.2	0.33
Beta blocker	88.9	87.9	85.9	0.19
ACE Inhibitor	76.4	79.0	78.8	0.31
Lipid lowering agent	85.4	81.7	73.4	< 0.0001
IRA-LAD (%)	32.9	36.8	38.4	0.19
IRA-Circ (%)	18.1	13.9	15.0
IRA-RCA (%)	49.0	49.3	46.6
IRA TIMI Flow Grade 0-1 (%)	99.8	99.5	99.4	0.41
Two or three vessel disease (%)	15.5	17.3	21.6	0.03
Collaterals present (Grade 1 and 2) (%)	89.2	88.5	86.7	0.29
Mitral regurgitation (%)
Grade 0	69.0	66.1	56.9	< 0.0001b
Grade 1	27.3	28.3	30.6
Grade 2	2.7	4.4	7.4
Grade 3	1.0	1.2	5.1
End-diastolic volume (mL) (n = 201)	137.4 ± 55.1	124.1 ± 52.8	130.4 ± 85.6	0.36
End-systolic volume ± mL) (n = 201)	70.7 ± 32.7	64.5 ± 32.2	71.7 ± 54.2	0.45
Ejection fraction (n = 2145)	48.2 ± 10.0	47.9 ± 11.3	46.2 ± 12.1	0.02
Wall motion SD/Chord (n = 1677)	-2.9 ± 0.9	-2.9 ± 0.9	-3.0 ± 0.9	0.84
Systolic sphericity index (n = 1677)	23.3 ± 6.9	22.9 ± 6.6	24.7 ± 8.5	0.003
Diastolic sphericity index (n = 1677)	30.0 ± 6.7	30.6 ± 6.5	31.5 ± 7.4	0.02

^bP < 0.0001 for linear association between eGFR group and mitral regurgitation grade; P < 0.002 for linear association between eGFR group and presence of mitral regurgitation (grade ≥ 1). ULN: Upper limit of the local laboratory normal; LAD: Left anterior descending coronary artery; RCA: Right coronary artery; Circ: Left circumflex coronary artery; TIMI: Thrombolysis in myocardial infarction; BMI: Body mass index.

Table 2 Multivariable correlates of heart failure

Covariates	P value	OR	95% CI
All patients (n = 2096)
Decreasing EF1	< 0.0001	1.554	1.398-1.727
Increasing BMI	0.001	1.037	1.015-1.059
Decreasing eGFR1	0.006	1.088	1.025-1.156
Increasing age1	0.007	1.171	1.044-1.315
Increasing heart rate1	0.001	1.183	1.075-1.302
Collaterals not present (Grade 0)	0.045	1.397	1.007-1.939
Patients with preserved EF (n = 1402)
Increasing BMI	0.0001	1.060	1.029-1.093
Decreasing eGFR1	0.003	1.140	1.044-1.245
Prior MI	0.021	1.701	1.082-2.673
Increasing age1	0.031	1.185	1.015-1.383
Increasing heart rate1	0.030	1.161	1.014-1.328
Patients with depressed EF (n = 715)
Decreasing EF1	< 0.0001	2.096	1.633-2.689
Decreasing eGFR1	0.181	1.056	0.975-1.143
Increasing heart rate1	0.006	1.210	1.055-1.388
Collaterals not present (Grade 0)	0.036	1.632	1.032-2.581

¹Odds ratios (ORs) and confidence intervals (CIs) reported for a 10 unit change. The addition of an EF*eGFR interaction term did not contribute significantly to the model for all patients, when EF within the interaction term was entered as a continuous variable (P = 0.575) or as a dichotomous variable, i.e. preserved vs depressed (P = 0.151).