title: Influence of renal impairment on myocardial function in outpatients with systolic heart failure: an echocardiographic and cardiac biomarker study.
abstract: BACKGROUND
  Renal dysfunction (RD) is associated with poor outcome in systolic heart failure (HF). Left ventricular ejection fraction (LVEF) is not depressed to a greater extent in patients with RD compared to patients with normal renal function, but it is relatively unknown whether other measures of myocardial function are impaired by RD. The objective of the present study is to evaluate whether RD in systolic HF is associated with excessive impairment of myocardial function, evaluated by strain analysis and cardiac biomarkers.
  
  
  METHODS
  Patients with LVEF <0.45% were enrolled from an outpatient HF clinic. The patients underwent advanced echocardiography. Glomerular filtration rate was estimated by the CKD-EPI equation (eGFR) and patients grouped by eGFR: eGFR group-I, ≥ 90 ml/min/1.73 m(2); eGFR group-II, 60-89 ml/min/1.73 m(2); and eGFR group-III, ≤ 59 ml/min/1.73 m(2). Multivariate regression models were developed to evaluate the associations between eGFR groups, echocardiographic measures and cardiac biomarkers.
  
  
  RESULTS
  A total of 149 patients participated in the study. Median age was 69 years, 26% were female; LVEF was 33%. Patients with a low eGFR were older (P < 0.001), but there were no differences in frequency of atrial fibrillation, hypertension, diabetes and ischemic heart disease between eGFR groups (P > 0.05 for all). RD was associated with impaired global longitudinal strain (P = 0.018), increased E/e' (P = 0.032), larger left atria (P = 0.038) and increased levels of proANP (P < 0.001), NT-proBNP (P < 0.001) and troponin I (P = 0.019) after adjustment for traditional confounders.
  
  
  CONCLUSIONS
  Echocardiographic measures and biomarkers reflecting different aspects of myocardial function are impaired in systolic HF patients with RD and the increased mortality risk in these patients may partly be explained by a depressed cardiac function.
authors.affiliation: Department of Cardio-, Nephro- and Endocrinology, North Zealand Hospital, University of Copenhagen, Denmark. Electronic address: hbos0002@regionh.dk.
authors.forename: Helle
authors.initials: H
authors.lastname: Bosselmann
authors.affiliation: Department of Cardio-, Nephro- and Endocrinology, North Zealand Hospital, University of Copenhagen, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Tonder
authors.affiliation: Department of Clinical Biochemestry, North Zealand Hospital, University of Copenhagen, Denmark.
authors.forename: György
authors.initials: G
authors.lastname: Sölétormos
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Rossing
authors.affiliation: Department of Cardio-, Nephro- and Endocrinology, North Zealand Hospital, University of Copenhagen, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Iversen
authors.affiliation: Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Goetze
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.affiliation: Department of Cardio-, Nephro- and Endocrinology, North Zealand Hospital, University of Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000639:trends; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D054143:Heart Failure, Systolic / Q000097:blood* / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000097:blood* / Q000000981:diagnostic imaging* / Q000401:mortality; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; C552580:midregional pro-atrial natriuretic peptide, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor
keywords: Cardiorenal syndrome; Echocardiography; Global longitudinal strain; Left atrial volume index; Renal function; Systolic heart failure