Association Between Renal Function and Cardiovascular Structure and Function in Heart Failure With Preserved Ejection Fraction
What are associations between albuminuria and/or low estimated glomerular filtration rate (eGFR) and cardiovascular structure and function in patients with heart failure with preserved ejection fraction (HFpEF)?
This was a retrospective analysis of select patients in the PARAMOUNT (Prospective comparison of ARNI with ARB on Management Of heart failUre with preserved ejectioN fracTion) trial. Eligible participants had echocardiography and measures of kidney function. The authors examined relations between renal dysfunction (by eGFR >30 and <60 ml/min/1.73 m2 and/or albuminuria) and cardiovascular structure/function.
A total of 62% of patients had impairment of at least one parameter of kidney function. Compared to patients with normal GFR, those with low eGFR and no albuminuria had a higher prevalence of abnormal left ventricular (LV) geometry (defined as concentric hypertrophy, eccentric hypertrophy, or concentric remodeling, p = 0.032) and lower midwall fractional shortening (p < 0.01). Albuminuria alone was associated with greater LV dimensions (p < 0.05).
There are significant associations between albuminuria and/or low eGFR with abnormalities in cardiovascular structure/function (e.g., LV wall thickness, abnormal LV geometry, and/or midwall fractional shortening) in patients with HFpEF.
Although limited by a small sample size and the reality that cross-sectional data cannot generate conclusions about causality, this is a valuable study establishing that abnormalities in renal function are highly prevalent in patients with HFpEF, and are associated with cardiac remodeling and subtle systolic dysfunction. Such observations warrant further study and certainly support consideration of both eGFR and proteinuria as markers of renal dysfunction that may be important to characterize in HFpEF patients.
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