Korean Circulation Journal

  • 제47권5호
  • /
  • Pages.727-741
  • /
  • 2017
  • /
  • 1738-5520(pISSN)
  • /
  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
권호 표지
DOI QR코드

DOI QR Code

Relation of Renal Function with Left Ventricular Systolic Function and NT-proBNP Level and Its Prognostic Implication in Heart Failure with Preserved versus Reduced Ejection Fraction: an analysis from the Korean Heart Failure (KorHF) Registry

  • Park, Chan Soon (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Park, Jin Joo (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Oh, Il-Young (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Yoon, Chang-Hwan (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Choi, Dong-Ju (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Park, Hyun-Ah (Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Kang, Seok-Min (Division of Cardiology, Yonsei University Severance Hospital) ;
  • Yoo, Byung-Su (Division of Cardiology, Yonsei University Wonju Severance Christian Hospital) ;
  • Jeon, Eun-Seok (Department of Internal Medicine, Sungkyunkwan University College of Medicine, Samsung Medical Center) ;
  • Kim, Jae-Joong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cho, Myeong-Chan (Department of Internal Medicine, Chungbuk National University College of Medicine) ;
  • Chae, Shung Chull (Department of Internal Medicine, Kyungpook National University College of Medicine) ;
  • Ryu, Kyu-Hyung (Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital) ;
  • Oh, Byung-Hee (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital)
  • 투고 : 2017.03.09
  • 심사 : 2017.06.06
  • 발행 : 2017.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Objectives: The relationship between ejection fraction (EF), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and renal function is unknown as stratified by heart failure (HF) type. We investigated their relation and the prognostic value of renal function in heart failure with preserved ejection fraction (HFpEF) vs. reduced ejection fraction (HFrEF). Materials and Methods: NT-proBNP, glomerular filtration rate (GFR), and EF were obtained in 1,932 acute heart failure (AHF) patients. HFrEF was defined as EF<50%, and renal dysfunction as GFR<$60mL/min/1.73m^2$ (mild renal dysfunction: $30{\leq}GFR$<$60mL/min/1.73m^2$; severe renal dysfunction: GFR<$30mL/min/1.73m^2$). The primary outcome was 12-month all-cause death. Results: There was an inverse correlation between GFR and log NT-proBNP level (r=-0.298, p<0.001), and between EF and log NT-proBNP (r=-0.238, p<0.001), but no correlation between EF and GFR (r=0.017, p=0.458). Interestingly, the prevalence of renal dysfunction did not differ between HFpEF and HFrEF (49% vs. 52%, p=0.210). Patients with renal dysfunction had higher 12-month mortality in both HFpEF (7.9% vs. 15.2%, log-rank p=0.008) and HFrEF (8.6% vs. 16.8%, log-rank p<0.001). Multivariate analysis showed severe renal dysfunction was an independent predictor of 12-month mortality (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.40-3.11). When stratified according to EF: the prognostic value of severe renal dysfunction was attenuated in HFpEF patients (HR, 1.46; 95% CI, 0.66-3.21) contrary to HFrEF patients (HR, 2.43; 95% CI, 1.52-3.89). Conclusion: In AHF patients, the prevalence of renal dysfunction did not differ between HFpEF and HFrEF patients. However, the prognostic value of renal dysfunction was attenuated in HFpEF patients.

키워드

과제정보

연구 과제 주관 기관 : Korean Society of Heart Failure, Korean Society of Cardiology

참고문헌

  1. WRITING GROUP MEMBERSLloyd-Jones D, Adams RJ, et al. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation 2010;121:e46-215.
  2. Lee JH, Lim NK, Cho MC, Park HY. Epidemiology of heart failure in Korea: present and future. Korean Circ J 2016;46:658-64. https://doi.org/10.4070/kcj.2016.46.5.658
  3. Youn JC, Han S, Ryu KH. Temporal trends of hospitalized patients with heart failure in Korea. Korean Circ J 2017;47:16-24. https://doi.org/10.4070/kcj.2016.0429
  4. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol 2008;52:1527-39. https://doi.org/10.1016/j.jacc.2008.07.051
  5. Januzzi JL, van Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-probnp Study. Eur Heart J 2006;27:330-7. https://doi.org/10.1093/eurheartj/ehi631
  6. Seino Y, Ogawa A, Yamashita T, et al. Application of NT-proBNP and BNP measurements in cardiac care: a more discerning marker for the detection and evaluation of heart failure. Eur J Heart Fail 2004;6:295-300. https://doi.org/10.1016/j.ejheart.2003.12.009
  7. O'Donoghue M, Chen A, Baggish AL, et al. The effects of ejection fraction on N-terminal ProBNP and BNP levels in patients with acute CHF: analysis from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study. J Card Fail 2005;11:S9-14. https://doi.org/10.1016/j.cardfail.2004.04.003
  8. van Veldhuisen DJ, Linssen GC, Jaarsma T, et al. B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol 2013;61:1498-506. https://doi.org/10.1016/j.jacc.2012.12.044
  9. Choi DJ, Han S, Jeon ES, et al. Characteristics, outcomes and predictors of long-term mortality for patients hospitalized for acute heart failure: a report from the Korean heart failure registry. Korean Circ J 2011;41:363-71. https://doi.org/10.4070/kcj.2011.41.7.363
  10. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993;88:107-15. https://doi.org/10.1161/01.CIR.88.1.107
  11. Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006;145:247-54. https://doi.org/10.7326/0003-4819-145-4-200608150-00004
  12. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006;355:251-9. https://doi.org/10.1056/NEJMoa052256
  13. Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 2011;32:670-9. https://doi.org/10.1093/eurheartj/ehq426
  14. Anwaruddin S, Lloyd-Jones DM, Baggish A, et al. Renal function, congestive heart failure, and amino-terminal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study. J Am Coll Cardiol 2006;47:91-7. https://doi.org/10.1016/j.jacc.2005.08.051
  15. Luchner A, Hengstenberg C, Lowel H, Riegger GA, Schunkert H, Holmer S. Effect of compensated renal dysfunction on approved heart failure markers: direct comparison of brain natriuretic peptide (BNP) and N-terminal pro-BNP. Hypertension 2005;46:118-23. https://doi.org/10.1161/01.HYP.0000170140.36633.8f
  16. Nakagawa O, Ogawa Y, Itoh H, et al. Rapid transcriptional activation and early mRNA turnover of brain natriuretic peptide in cardiocyte hypertrophy. Evidence for brain natriuretic peptide as an "emergency" cardiac hormone against ventricular overload. J Clin Invest 1995;96:1280-7. https://doi.org/10.1172/JCI118162
  17. Kang SH, Park JJ, Choi DJ, et al. Prognostic value of NT-proBNP in heart failure with preserved versus reduced EF. Heart 2015;101:1881-8. https://doi.org/10.1136/heartjnl-2015-307782
  18. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 2013;62:263-71. https://doi.org/10.1016/j.jacc.2013.02.092
  19. Ter Maaten JM, Damman K, Verhaar MC, et al. Connecting heart failure with preserved ejection fraction and renal dysfunction: the role of endothelial dysfunction and inflammation. Eur J Heart Fail 2016;18:588-98. https://doi.org/10.1002/ejhf.497
  20. Bidani AK, Polichnowski AJ, Loutzenhiser R, Griffin KA. Renal microvascular dysfunction, hypertension and CKD progression. Curr Opin Nephrol Hypertens 2013;22:1-9. https://doi.org/10.1097/MNH.0b013e32835b36c1
  21. Brown WV. Microvascular complications of diabetes mellitus: renal protection accompanies cardiovascular protection. Am J Cardiol 2008;102:10L-13L. https://doi.org/10.1016/j.amjcard.2008.09.068
  22. Tang WH, Mullens W. Cardiorenal syndrome in decompensated heart failure. Heart 2010;96:255-60. https://doi.org/10.1136/hrt.2009.166256
  23. Hillege HL, Nitsch D, Pfeffer MA, et al. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation 2006;113:671-8. https://doi.org/10.1161/CIRCULATIONAHA.105.580506
  24. Schrier RW. Role of diminished renal function in cardiovascular mortality: marker or pathogenetic factor? J Am Coll Cardiol 2006;47:1-8. https://doi.org/10.1016/j.jacc.2005.07.067
  25. Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J 2014;35:455-69. https://doi.org/10.1093/eurheartj/eht386
  26. Dries DL, Exner DV, Domanski MJ, Greenberg B, Stevenson LW. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2000;35:681-9. https://doi.org/10.1016/S0735-1097(99)00608-7
  27. de Silva R, Nikitin NP, Witte KK, et al. Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis. Eur Heart J 2006;27:569-81. https://doi.org/10.1093/eurheartj/ehi696
  28. Rusinaru D, Buiciuc O, Houpe D, Tribouilloy C. Renal function and long-term survival after hospital discharge in heart failure with preserved ejection fraction. Int J Cardiol 2011;147:278-82. https://doi.org/10.1016/j.ijcard.2009.09.529
  29. Ahmed A, Rich MW, Sanders PW, et al. Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study. Am J Cardiol 2007;99:393-8. https://doi.org/10.1016/j.amjcard.2006.08.042
  30. Caruana L, Petrie MC, Davie AP, McMurray JJ. Do patients with suspected heart failure and preserved left ventricular systolic function suffer from “diastolic heart failure” or from misdiagnosis? A prospective descriptive study. BMJ 2000;321:215-8. https://doi.org/10.1136/bmj.321.7255.215

피인용 문헌

  1. Decompensated Heart Failure and Renal Failure: What Is the Current Evidence? vol.15, pp.4, 2018, https://doi.org/10.1007/s11897-018-0397-5