Phenotypic characteristics of patients with chronic heart failure and preserved ejection fraction in conjunction with chronic kidney disease
Abstract
Background. Heart failure with preserved ejection fraction (HFpEF) is a complex clinical condition, often associated with chronic kidney disease (CKD). The interplay between these two conditions remains underexplored. This study aims to examine the phenotypic characteristics of patients with HFpEF in conjunction with CKD, with a focus on biomarker alterations and clinical outcomes.
Materials and methods. The study enrolled 200 patients diagnosed with both HFpEF (ejection fraction ≥50%) and CKD stages 1-3b. Clinical data were collected, and various biomarkers, including NT-proBNP, cystatin C, and microalbuminuria (MAU), were measured using chemiluminescent immunoassay (COBAS e411, Roche HITACHI), fluorescent immunoassay (Finecare III PLUS analyzer), and turbidimetric testing (Mindray BS-380 analyzer), respectively. GFR was calculated using the CKD-EPI formula.
Results. The results indicated a higher prevalence of Type 2 diabetes (T2D) and atrial fibrillation (AF) among patients with CKD stage 3b. Conversely, those with CKD stage 3a exhibited worse control over blood lipid levels. Notably, a decrease in GFR was significantly correlated with elevated levels of creatinine, cystatin C, and MAU. In patients with CKD stages 1-2, even though creatinine levels were normal, cystatin C and MAU levels were higher than the normative range.
Conclusion. Among HFpEF patients, CKD stage 2 in combination with obesity was more common, with changes observed in renal biomarkers such as cystatin C and MAU, despite relatively normal GFR values. This highlights the importance of early detection and management of renal impairment in HFpEF patients, emphasizing a need for comprehensive cardiac and renal care.
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List of references
Hwang S.J., Melenovsky V., Borlaug B.A., Implications of coronary artery disease in heart failure with preserved ejection fraction, Journal of the American College of Cardiology, 2014, Jul, 1, 63, 025 Pt A, 2817-2827, 10.1016/j.jacc.2014.03.034, Epub 2014 Apr 23. PMID: 24768876.
Redfield M.M., Heart Failure with Preserved Ejection Fraction, New England Journal of Medicine, 2016, Nov, 10, 375, 019, 1868-1877, 10.1056/NEJMcp1511175, PMID: 27959663.
Paulus W.J., Tscho¨pe C., A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation, Journal of the American College of Cardiology, 2013, Jul, 23, 62, 04, 263-271, 10.1016/j.jacc.2013.02.092, Epub 2013 May 15. PMID: 23684677.
Mohammed S.F., Hussain S., Mirzoyev S.A., Edwards W.D., Maleszewski J.J., Redfield M.M., Coronary microvascular rarefaction and myocardial fibrosis in heart failure with preserved ejection fraction, Circulation, 2015, Feb, 10, 131, 06, 550-559, 10.1161/CIRCULATIONAHA.114.009625, Epub 2014 Dec 31. PMID: 25552356; PMCID: PMC4324362.
Lebedev D.A., Lyasnikova E.A., Vasilyeva E.Y., Babenko A.Y., Shlyakhto E.V., Type 2 Diabetes Mellitus and Chronic Heart Failure with Midrange and Preserved Ejection Fraction: A Focus on Serum Biomarkers of Fibrosis, Journal of Diabetes Research, 2020, Nov, 7, 2020, 6976153, 10.1155/2020/6976153, PMID: 33224989; PMCID: PMC7669344.
Smith D.H., Thorp M.L., Gurwitz J.H., McManus D.D., Goldberg R.J., Allen L.A., Hsu G., Sung S.H., Magid D.J., Go A.S., Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study, Circulation: Cardiovascular Quality and Outcomes, 2013, May, 1, 6, 03, 333-342, 10.1161/CIRCOUTCOMES.113.000221, Epub
2013 May 17. PMID: 23685625; PMCID: PMC3904800.
Lo¨fman I., Szummer K., Dahlstro¨m U., Jernberg T., Lund L.H., Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction, European Journal of Heart Failure, 2017, Dec, 19, 012, 1606-1614, 10.1002/ejhf.821, Epub 2017 Mar 29. PMID: 28371075.
Lejeune S., Roy C., Slimani A., Pasquet A., Vancraeynest D., Beauloye C., Vanoverschelde J.L., Gerber B.L., Pouleur A.C., Heart failure with preserved ejection fraction in Belgium: characteristics and outcome of a real-life cohort, Acta Cardiologica, 2021, Sep, 76, 07, 697-706, 10.1080/00015385.2020.1770460, Epub 2020 Jul 17. PMID: 32677871.
Tromp J., Teng T.H., Tay W.T., Hung C.L., Narasimhan C., Shimizu W., Park S.W., Liew H.B., Ngarmukos T., Reyes E.B., Siswanto B.B., Yu C.M., Zhang S., Yap J., MacDonald M., Ling L.H., Leineweber K., Richards A.M., Zile M.R., Anand I.S., Lam C.S.P., Heart failure with preserved ejection fraction in Asia, European Journal of Heart Failure, 2019, Jan, 21, 01, 23-36, 10.1002/ejhf.1227, Epub 2018 Aug 16. PMID: 30113120.
Solomon S.D., McMurray J.J.V., Anand I.S., Ge J., Lam C.S.P., Maggioni A.P., Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction, New England Journal of Medicine, 2019, Oct, 24, 381, 017, 1609-1620, 10.1056/NEJMoa1908655, Epub 2019 Sep 1. PMID: 31475794.
Unger E.D., Dubin R.F., Deo R., Daruwalla V., Friedman J.L., Medina C., Association of chronic kidney disease with abnormal cardiac mechanics and adverse outcomes in patients with heart failure and preserved ejection fraction, European Journal of Heart Failure, 2016, 18, 103-112, https://api.semanticscholar.org/CorpusID:34833152.
Patel R.B., Mehta R., Redfield M.M., Borlaug B.A., Hernandez A.F., Shah S.J., Dubin R.F., Renal Dysfunction in Heart Failure With Preserved Ejection Fraction: Insights From the RELAX Trial, Journal of Cardiac Failure, 2020, Mar, 26, 03, 233-242, 10.1016/j.cardfail.2020.01.003, Epub 2020 Jan 11. PMID: 31931098; PMCID: PMC7078015.
Lejeune S., Roy C., Slimani A., Pasquet A., Vancraeynest D., Beauloye C., Vanoverschelde J.L., Gerber B.L., Pouleur A.C., Heart failure with preserved ejection fraction in Belgium: characteristics and outcome of a real-life cohort, Acta Cardiologica, 2021, Sep, 76, 07, 697-706, 10.1080/00015385.2020.1770460, Epub 2020 Jul 17. PMID: 32677871.
Beldhuis I.E., Myhre P.L., Claggett B., Damman K., Fang J.C., Lewis E.F., O’Meara E., Pitt B., Shah S.J., Voors A.A., Pfeffer M.A., Solomon S.D., Desai A.S., Efficacy and Safety of Spironolactone in Patients With HFpEF and Chronic Kidney Disease, JACC: Heart Failure, 2019, Jan, 7, 01, 25-32, 10.1016/j.jchf.2018.10.017, PMID: 30606484.
Shah S.J., Katz D.H., Selvaraj S., Burke M.A., Yancy C.W., Gheorghiade M., Bonow R.O., Huang C.C., Deo R.C., Phenomapping for novel classification of heart failure with preserved ejection fraction, Circulation, 2015, Jan, 20, 131, 03, 269-279, 10.1161/CIRCULATIONAHA.114.010637, Epub 2014 Nov 14. PMID: 25398313; PMCID: PMC4302027.
Patel R.B., Mehta R., Redfield M.M., Borlaug B.A., Hernandez A.F., Shah S.J., Dubin R.F., Renal Dysfunction in Heart Failure With Preserved Ejection Fraction: Insights From the RELAX Trial, Journal of Cardiac Failure, 2020, Mar, 26, 03, 233-242, 10.1016/j.cardfail.2020.01.003, Epub 2020 Jan 11. PMID: 31931098; PMCID: PMC7078015.
Unger E.D., Dubin R.F., Deo R., Daruwalla V., Friedman J.L., Medina C., Association of chronic kidney disease with abnormal cardiac mechanics and adverse outcomes in patients with heart failure and preserved ejection fraction, European Journal of Heart Failure, 2016, 18, 103-112, 10.1002/ejhf.348, Corpus ID: 34833152.
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