Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Cardiology Division, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Cardiorenal Med. 2018;8(2):123-129. doi: 10.1159/000486629. Epub 2018 Feb 28.
In patients with heart failure with preserved ejection fraction (HFpEF), worse kidney function is associated with worse overall cardiac mechanics. Right ventricular stroke work index (RVSWI) is a parameter of right ventricular function. The aim of our study was to determine the relationship between RVSWI and glomerular filtration rate (GFR) in patients with HFpEF.
This was a single-center cross-sectional study. HFpEF is defined as patients with documented heart failure with ejection fraction > 50% and pulmonary wedge pressure > 15 mm Hg from right heart catheterization. RVSWI (normal value 8-12 g/m/beat/m2) was calculated using the formula: RVSWI = 0.0136 × stroke volume index × (mean pulmonary artery pressure - mean right atrial pressure). Univariate and multivariate linear regression analysis was performed to study the correlation between RVSWI and GFR.
Ninety-one patients were included in the study. The patients were predominantly female (n = 64, 70%) and African American (n = 61, 67%). Mean age was 66 ± 12 years. Mean GFR was 59 ± 35 mL/min/1.73 m2. Mean RVSWI was 11 ± 6 g/m/beat/m2. Linear regression analysis showed that there was a significant independent inverse relationship between RVSWI and GFR (unstandardized coefficient = -1.3, p = 0.029). In the subgroup with combined post and precapillary pulmonary hypertension (Cpc-PH) the association remained significant (unstandardized coefficient = -1.74, 95% CI -3.37 to -0.11, p = 0.04).
High right ventricular workload indicated by high RVSWI is associated with worse renal function in patients with Cpc-PH. Further prospective studies are needed to better understand this association.
在射血分数保留的心力衰竭（HFpEF）患者中，肾功能越差，整体心脏力学越差。右心室每搏功指数（RVSWI）是右心室功能的一个参数。我们的研究目的是确定 HFpEF 患者的 RVSWI 与肾小球滤过率（GFR）之间的关系。
这是一项单中心横断面研究。HFpEF 的定义为经右心导管检查证实的射血分数>50%且肺楔压>15mmHg 的心力衰竭患者。使用公式计算 RVSWI：RVSWI=0.0136×每搏量指数×（平均肺动脉压-平均右心房压）。进行单变量和多变量线性回归分析，以研究 RVSWI 与 GFR 之间的相关性。
研究纳入了 91 例患者。患者主要为女性（n=64，70%）和非裔美国人（n=61，67%）。平均年龄为 66±12 岁。平均 GFR 为 59±35mL/min/1.73m2。平均 RVSWI 为 11±6g/m/beat/m2。线性回归分析显示，RVSWI 与 GFR 之间存在显著的负相关关系（标准化系数=-1.3，p=0.029）。在合并后和前毛细血管性肺动脉高压（Cpc-PH）的亚组中，这种关联仍然显著（标准化系数=-1.74，95%置信区间-3.37 至-0.11，p=0.04）。
高 RVSWI 提示右心室工作量高与 Cpc-PH 患者的肾功能差有关。需要进一步的前瞻性研究来更好地理解这种关联。
