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      Association between Impaired Renal Function and Subclinical Myocardial Dysfunction in Patients with Heart Failure with Preserved Ejection Fraction: Assessment Using Noninvasive Pressure-Strain Loop

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          Abstract

          Introduction: The objective of this study was to evaluate the abnormal myocardial function in HFpEF patients with renal dysfunction (RD) and investigate the relationship between renal function and myocardial mechanical characteristics in patients with HFpEF. Methods: 134 patients with HFpEF and 32 control subjects were enrolled in our study. Clinical and echocardiography data were collected for offline analysis. Global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE) were measured after noninvasive pressure-strain loop analysis. Univariate and multivariate analyses were used to determine the correlation between renal function and myocardial function in patients with HFpEF. Results: In comparison to control subjects, patients with HFpEF tend to have higher GWW (78 [50–115] vs. 108 [65–160] mm Hg%, p < 0.05) and lower GWE (96 [95–97] vs. 95 [92–96] %, p < 0.05), while left ventricular ejection fraction (65.5 ± 3.3 vs. 64.3 ± 4.6%, p < 0.05) was comparable between them. Besides, increased GWW (86 [58–152] vs. 125 [94–187] mm Hg%, p < 0.05) and decreased GWE (96 [93–97] vs. 94 [92–96] %, p < 0.05) were detected in patients with RD compared to those with normal renal function. An independent correlation was found between estimated glomerular filtration rate and GWW after multivariate analysis. Discussion/Conclusion: More severely impaired myocardial function was detected in HFpEF patients with RD compared to those with normal renal function. Estimated glomerular filtration rate was independently correlated to GWW in patients with HFpEF.

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          Most cited references38

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          2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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            Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

            The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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              2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

              The “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” replaces the “2013 ACCF/AHA Guideline for the Management of Heart Failure” and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.” The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients’ interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2024
                March 2024
                23 November 2023
                : 149
                : 2
                : 117-126
                Affiliations
                [a ]Department of Ultrasound Medical, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
                [b ]Department of GE Clinical Education Team, General Electric Company, Beijing, China
                Author notes
                *Xiuzhang Lu, lxz_echo@163.com, Qizhe Cai, echocaiqizhe@163.com
                Article
                535371 Cardiology 2024;149:117–126
                10.1159/000535371
                37995663
                a1269018-88d8-46c3-b664-3a76cf8558cf
                © 2023 S. Karger AG, Basel
                History
                : 09 May 2023
                : 11 November 2023
                Page count
                Figures: 3, Tables: 2, Pages: 10
                Funding
                This study was supported by Beijing Hospitals Authority Youth Programme, code: QML 20180302.
                Categories
                Cardiovascular Imaging: Research Article

                Medicine
                Renal dysfunction,Myocardial mechanical function,Heart failure with preserved ejection fraction,Global myocardial work

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