title: Mortality after myocardial infarction: the role of renal function and systolic and diastolic functions of the left ventricle.
abstract: BACKGROUND
  The relationship between renal dysfunction and mortality after myocardial infarction (MI) has been demonstrated in patients with reduced ejection fraction. The importance of diastolic dysfunction in this scenario is unknown.
  
  
  METHODS
  We studied 749 patients with acute MI who were evaluated within 24 hours of symptom onset. The Modification of Diet in Renal Disease equation was used to calculate the estimated glomerular filtration rate (eGFR). Preserved and depressed renal functions were defined as eGFR >60 and <60 mL/min, respectively. Diastolic function was determined by echocardiography and classified as normal or mildly, moderately or severely reduced. The left ventricular systolic function (cutoff of 0.55) was assessed by echocardiography.
  
  
  RESULTS
  The mean age of the cohort was 62 years (±13 years); 61.3% were male, 70.2% were hypertensive, 32% were diabetic and 34.8% had hyperlipidemia. Seventy-eight patients died in hospital (10.4%), and 319 (42.6%) had an eGFR <60 mL/min. Diastolic dysfunction was present in 520 (69.4%) patients. Renal function was independently associated with worse in-hospital mortality (adjusted odds ratio 3.12, 95% confidence interval 1.71-5.69, per 10 mL/min  decrease in eGFR <60 mL/min). For patients with normal-to-moderate diastolic dysfunction, normal renal function was not associated with increased in-hospital mortality (p-interaction = 0.01).
  
  
  CONCLUSIONS
  Impaired renal function and both systolic and diastolic dysfunctions were associated with worse in-hospital mortality. However, normal-to-moderate diastolic dysfunction in the presence of normal renal function was not associated with worse outcome.  Efforts to preserve renal function in patients with acute myocardial infarction should be made, particularly  in those with diastolic dysfunction.
authors.affiliation: Federal University of São Paulo, SP - Brazil.
authors.forename: Rudyney E U
authors.initials: RE
authors.lastname: Azevedo
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Maria Eugênia F
authors.initials: ME
authors.lastname: Canziani
authors.forename: Iran
authors.initials: I
authors.lastname: Gonçalves
authors.forename: Paulo Cesar G D
authors.initials: PC
authors.lastname: Campos
authors.forename: Marcelo L C
authors.initials: ML
authors.lastname: Vieira
authors.forename: Edson
authors.initials: E
authors.lastname: Stefanini
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003971:Diastole; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology