The relationship between renal function and cardiac structure, function, and prognosis after myocardial infarction: the VALIANT Echo Study.
OBJECTIVE
The purpose of this study was to determine whether alterations in cardiac structure or function contribute to the increased risk associated with renal impairment after myocardial infarction (MI).


BACKGROUND
Renal impairment is associated with adverse cardiovascular outcomes after MI.


METHODS
Echocardiography was performed on 603 patients with left ventricular (LV) dysfunction, heart failure (HF), or both after MI. Patients were grouped according to their estimated glomerular filtration rate (eGFR), and measures of cardiac structure and function were related to baseline eGFR. The relationship between eGFR and cardiac structure and function and clinical outcomes of death or HF was assessed with multivariable Cox regression.


RESULTS
Ejection fraction, infarct segment length, right ventricular function, and mitral deceleration time were not influenced by renal function. Patients with reduced eGFR had smaller LV and larger left atrial (LA) volumes and higher left ventricular mass index (LVMI) and LV mass/LV volume ratio. A greater proportion of the patients with reduced eGFR had LV hypertrophy. The relationship between eGFR and the outcome of death or HF was attenuated by including baseline differences in LVMI, and both LVMI and LA volume conferred additional prognostic information in a multivariable model.


CONCLUSIONS
Renal impairment was associated with smaller LV and larger LA volumes and increased LVMI. Systolic function was similar when compared with patients with normal renal function. Thus, reduced systolic function cannot account for worse outcomes in patients with renal impairment after MI. Indirect measures of diastolic function suggest that diastolic dysfunction might be an important mediator of increased risk in this population.
Verma
Anil
A
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Anavekar
Nagesh S
NS
Meris
Alessandra
A
Thune
Jens Jakob
JJ
Arnold
J Malcolm O
JM
Ghali
Jalal K
JK
Velazquez
Eric J
EJ
McMurray
John J V
JJ
Pfeffer
Marc A
MA
Solomon
Scott D
SD
D000368:Aged; D002306:Cardiac Volume / Q000502:physiology*; D003404:Creatinine / Q000097:blood; D003971:Diastole / Q000502:physiology; D005260:Female; D005919:Glomerular Filtration Rate; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D018615:Ultrasonography, Doppler, Color; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
D003404:Creatinine