Cardiovascular Center OLV Hospital, Aalst, Belgium.
Athens Naval and Veterans Hospital, Athens, Greece.
Curr Med Res Opin. 2020 Mar;36(3):353-359. doi: 10.1080/03007995.2019.1708286. Epub 2020 Jan 6.
Right but not left ventricular hemodynamic parameters have been found to be independently associated with adverse renal outcomes in patients with acute decompensated heart failure (HF). To investigate the hemodynamic profile of patients without acute decompensated heart failure and left ventricular ejection fraction >50% referred for elective left and right heart catheterization and to correlate left and right filling pressures, stroke volume and arterial blood pressure to renal function parameters. Subsequently, we tested the hypothesis that right ventricle and left ventricle hemodynamic parameters can predict all-cause mortality in our non-HF subjects. Between October 2009 and November 2010, 151 consecutive patients referred for elective left and right heart catheterization were studied and consequently followed up for a mean period of 8 years in order to identify all-cause mortality. Patient's initial cohort was subdivided in two groups according to right atrial pressure. The RAPR group (Right Atrium Pressure ≤ 9 mmHg) and the RAPR group (Right Atrium Pressure > 9mmHg) No correlation between blood pressure, pulmonary capillary wedges pressure, cardiac index, stroke volume and stroke volume index (SVI), and parameters of kidney function was observed. However, a weak, although, significant correlation between right atrial pressure (RAP) and modification of diet in renal disease (MDRD) ( = -0.202; = .014) could be detected. RAPR patients had a statistically significant lower MDRD value of 16.6 mL/min/1.73 m than RAPR patients. Increased RAP (HR = 2.03; 95% [CI]: 1.05 to 3.9; = .025) and age (HR = 1.08, 95% [CI] 1.04-1.12, < .001) independently predicted all-cause mortality during follow up. Our study demonstrates that right ventricular preload affects renal function in patients with preserved systolic function and that neither aortic systolic pressure nor left ventricle pressure indices were related to estimated glomerular filtration rate. Furthermore, we demonstrate for the first time that an increased RAP is able to predict a worse prognosis in patients with preserved ejection fraction independently of well-established risk factors, such as blood pressure and SVI.
右心室而非左心室血流动力学参数已被发现与急性失代偿性心力衰竭（HF）患者的不良肾脏结局独立相关。本研究旨在探讨射血分数＞50%、无急性失代偿性心力衰竭而接受择期左、右心导管检查的患者的血流动力学特征，并将左、右心室充盈压、心排量和动脉血压与肾功能参数相关联。随后，我们检验了这样一个假设，即右心室和左心室血流动力学参数可以预测非 HF 患者的全因死亡率。2009 年 10 月至 2010 年 11 月，对 151 例连续接受择期左、右心导管检查的患者进行了研究，并随后进行了平均 8 年的随访，以确定全因死亡率。根据右心房压力（RAP）将患者的初始队列分为两组。RAPR 组（右心房压力≤9mmHg）和 RAPR 组（右心房压力＞9mmHg）。血压、肺毛细血管楔压、心指数、心排量和心排量指数（SVI）与肾功能参数之间无相关性。然而，在右心房压力（RAP）与改良肾脏病饮食研究（MDRD）之间可以检测到微弱但有统计学意义的相关性（ = -0.202； = .014）。RAPR 患者的 MDRD 值为 16.6 mL/min/1.73 m，明显低于 RAPR 患者。增加的 RAP（HR = 2.03；95%置信区间：1.05 至 3.9； = .025）和年龄（HR = 1.08，95%置信区间 1.04-1.12， < .001）在随访期间独立预测全因死亡率。我们的研究表明，在收缩功能正常的患者中，右心室前负荷会影响肾功能，而主动脉收缩压和左心室压力指数与估计肾小球滤过率均无相关性。此外，我们首次证明，在射血分数正常的患者中，增加的 RAP 能够独立于血压和 SVI 等既定的危险因素预测预后不良。
