title: Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure: a 7-year follow-up study.
abstract: BACKGROUND
  Renal dysfunction is associated with a variety of cardiac alterations including left ventricular (LV) hypertrophy, LV dilation, and reduction in systolic and diastolic function. It is common and associated with an increased mortality risk in heart failure (HF) patients. This study was designed to evaluate whether severe diastolic dysfunction contribute to the increased mortality risk observed in HF patients with renal dysfunction.
  
  
  METHODS
  Using Cox Proportional Hazard Models on data (N = 669) from the EchoCardiography and Heart Outcome Study (ECHOS) study we evaluated whether estimated glomerular filtration rate (eGFR) was associated with mortality risk before and after adjustment for severe diastolic dysfunction. Severe diastolic dysfunction was defined by a restrictive left ventricular filling pattern (RF) (=deceleration time < 140 ms) by Doppler echocardiography.
  
  
  RESULTS
  Median eGFR was 58 ml/min/1.73 m², left ventricular ejection fraction was 33% and RF was observed in 48%. During the 7 year follow up period 432 patients died. Multivariable adjusted eGFR was associated with similar mortality risk before (Hazard Ratio(HR)(eGFR 10 ml increase): 0.94 (95% CI: 0.89-0.99, P = 0.024) and after (HR(eGFR 10 ml increase): 0.93 (0.89-0.99), P = 0.012) adjustment for RF (HR: 1.57 (1.28-1.93), P < 0.001).
  
  
  CONCLUSIONS
  In patients admitted with HF RF does not contribute to the increased mortality risk observed in patients with a decreased eGFR. Factors other than severe diastolic dysfunction may explain the association between renal function and mortality risk in HF patients.
authors.affiliation: Department of Cardiology, The Heart Centre and University of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark. m.schou@dadlnet.dk.
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.forename: Dilek
authors.initials: D
authors.lastname: Akkan
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Moller
authors.forename: Lars
authors.initials: L
authors.lastname: Kober
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000401:mortality*; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality*