title: Association between renal function and cardiovascular structure and function in heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  Renal dysfunction is a common comorbidity in patients with heart failure and preserved ejection fraction (HFpEF). We sought to determine whether renal dysfunction was associated with measures of cardiovascular structure/function in patients with HFpEF.
  
  
  METHODS
  We studied 217 participants from the PARAMOUNT study with HFpEF who had echocardiography and measures of kidney function. We evaluated the relationships between renal dysfunction [estimated glomerular filtration rate (eGFR) >30 and <60 mL/min/1.73 m(2) and/or albuminuria] and cardiovascular structure/function.
  
  
  RESULTS
  The mean age of the study population was 71 years, 55% were women, 94% hypertensive, and 40% diabetic. Impairment of at least one parameter of kidney function was present in 62% of patients (16% only albuminuria, 23% only low eGFR, 23% both). Renal dysfunction was associated with abnormal LV geometry (defined as concentric hypertrophy, or eccentric hypertrophy, or concentric remodelling) (adjusted P = 0.048), lower midwall fractional shortening (MWFS) (P = 0.009), and higher NT-proBNP (P = 0.006). Compared with patients without renal dysfunction, those with low eGFR and no albuminuria had a higher prevalence of abnormal LV geometry (P = 0.032) and lower MWFS (P < 0.01), as opposed to those with only albuminuria. Conversely, albuminuria alone was associated with greater LV dimensions (P < 0.05). Patients with combined renal impairment had mixed abnormalities (higher LV wall thicknesses, NT-proBNP; lower MWFS).
  
  
  CONCLUSIONS
  Renal dysfunction, as determined by both eGFR and albuminuria, is highly prevalent in HFpEF, and associated with cardiac remodelling and subtle systolic dysfunction. The observed differences in cardiac structure/function between each type of renal damage suggest that both parameters of kidney function might play a distinct role in HFpEF.
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston 02445, MA, USA.
authors: Mauro
authors: M
authors: Gori
authors: Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors: Michele
authors: M
authors: Senni
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston 02445, MA, USA.
authors: Deepak K
authors: DK
authors: Gupta
authors: Renal Division and Clinical Biometrics, Brigham and Women's Hospital, Boston, MA, USA.
authors: David M
authors: DM
authors: Charytan
authors: Medical University Graz, Graz, Austria.
authors: Elisabeth
authors: E
authors: Kraigher-Krainer
authors: Medical University Graz, Graz, Austria.
authors: Burkert
authors: B
authors: Pieske
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston 02445, MA, USA.
authors: Brian
authors: B
authors: Claggett
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston 02445, MA, USA.
authors: Amil M
authors: AM
authors: Shah
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston 02445, MA, USA.
authors: Angela B S
authors: AB
authors: Santos
authors: Medical University of South Carolina, Charleston, SC, USA U.S. Department of Veterans Affairs, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
authors: Michael R
authors: MR
authors: Zile
authors: University of Groningen, Groningen, The Netherlands.
authors: Adriaan A
authors: AA
authors: Voors
authors: University of Glasgow, Glasgow, UK.
authors: John J V
authors: JJ
authors: McMurray
authors: University of Texas Southwestern, Dallas, TX, USA.
authors: Milton
authors: M
authors: Packer
authors: Novartis Pharmaceuticals, East Hanover, NJ, USA.
authors: Toni
authors: T
authors: Bransford
authors: Novartis Pharmaceuticals, East Hanover, NJ, USA.
authors: Martin
authors: M
authors: Lefkowitz
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston 02445, MA, USA ssolomon@rics.bwh.harvard.edu.
authors: Scott D
authors: SD
authors: Solomon
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000473:pathology / Q000503:physiopathology; D059347:Cardio-Renal Syndrome / Q000473:pathology / Q000503:physiopathology*; D003404:Creatinine / Q000652:urine; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology
chemical_list: D003404:Creatinine
keywords: Albuminuria; Cardiovascular structure and function; Chronic kidney disease; Glomerular filtration rate; Heart failure with preserved ejection fraction