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

World Journal of Cardiology 2010年第1期2卷 13-18页

作者： 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 Columbia University Division of Cardiology Mount Sinai Medical Center II Ischemic Heart Disease Department National Institute of Cardiology Leon Charney Division of Cardiology New York University School of Medicine Cardiology Division-Hospital Sao Paulo Federal University of Sao Paulo Division of Cardiology University of British Columbia Department of Cardiovascular Medicine Royal Perth Hospital Department of Cardiology UCL St Luc University Hospital INSERM U-698 Department of CardiologyHopital Bichat Cardiology Department Green Lane Cardiovascular ServiceAuckland City Hospital Interventional Cardiology Instituto de Intervenciones Cardiovasculares S.A. Cardiovascular Associates Wellmont Holston Valley Medical Center Cardiovascular Division University of Virginia Department of Medicine-Division of Cardiology York Hospital Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine Research Department Asheville Cardiology AssociatesP.A. Maryland Medical Research Institute

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 *** regression was used to explore independent predictors of ***: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 *** renal function was associated with an increased rate of early post-MI HF,the association being strongest in patients with preserved *** findings have implications for management of peri-infarct HF.

关键词： Heart failure Myocardial infarction Kidney disease

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