title: Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction.
abstract: 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.
authors.affiliation: Vinod Jorapur, Gervasio A Lamas, Ana C Mon, Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL 33140, United States.
authors.forename: Vinod
authors.initials: V
authors.lastname: Jorapur
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Zygmunt P
authors.initials: ZP
authors.lastname: Sadowski
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Buller
authors.forename: James M
authors.initials: JM
authors.lastname: Rankin
authors.forename: Jean
authors.initials: J
authors.lastname: Renkin
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Carlos
authors.initials: C
authors.lastname: Vozzi
authors.forename: Eduardo
authors.initials: E
authors.lastname: Balcells
authors.forename: Michael
authors.initials: M
authors.lastname: Ragosta
authors.forename: C Edwin
authors.initials: CE
authors.lastname: Martin
authors.forename: Vankeepuram S
authors.initials: VS
authors.lastname: Srinivas
authors.forename: William W
authors.initials: WW
authors.lastname: Wharton Iii
authors.forename: Staci
authors.initials: S
authors.lastname: Abramsky
authors.forename: Ana C
authors.initials: AC
authors.lastname: Mon
authors.forename: Shari S
authors.initials: SS
authors.lastname: Kronsberg
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman