Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction.
OBJECTIVE
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 m(2)) 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).


CONCLUSIONS
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.
Jorapur
Vinod
V
Vinod Jorapur, Gervasio A Lamas, Ana C Mon, Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL 33140, United States.
Lamas
Gervasio A
GA
Sadowski
Zygmunt P
ZP
Reynolds
Harmony R
HR
Carvalho
Antonio C
AC
Buller
Christopher E
CE
Rankin
James M
JM
Renkin
Jean
J
Steg
Philippe Gabriel
PG
White
Harvey D
HD
Vozzi
Carlos
C
Balcells
Eduardo
E
Ragosta
Michael
M
Martin
C Edwin
CE
Srinivas
Vankeepuram S
VS
Wharton Iii
William W
WW
Abramsky
Staci
S
Mon
Ana C
AC
Kronsberg
Shari S
SS
Hochman
Judith S
JS