Department of Cardiology, Sahlgrenska University Hospital, Blå stråket 5, 413 45, Gothenburg, Sweden.
Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
ESC Heart Fail. 2022 Aug;9(4):2654-2663. doi: 10.1002/ehf2.13990. Epub 2022 May 25.
Renal dysfunction in patients with heart failure (HF) has traditionally been attributed to declining cardiac output and renal hypoperfusion. However, other central haemodynamic aberrations may contribute to impaired kidney function. This study assessed the relationship between invasive central haemodynamic measurements from right-heart catheterizations and measured glomerular filtration rate (mGFR) in advanced HF.
All patients referred for heart transplantation work-up in Sweden between 1988 and 2019 were identified through the Scandiatransplant organ-exchange organization database. Invasive haemodynamic variables and mGFR were retrieved retrospectively. A total of 1001 subjects (49 ± 13 years; 24% female) were eligible for the study. Analysis of covariance adjusted for age, sex, and centre revealed that higher right atrial pressure (RAP) displayed the strongest relationship with impaired GFR [β coefficient -0.59; 95% confidence interval (CI) -0.69 to -0.48; P < 0.001], followed by lower mean arterial pressure (MAP) (β coefficient 0.29; 95% CI 0.14-0.37; P < 0.001), and finally reduced cardiac index (β coefficient 3.51; 95% CI 2.14-4.84; P < 0.003). A combination of high RAP and low MAP was associated with markedly worse mGFR than any other RAP/MAP profile, and high renal perfusion pressure (RPP, MAP minus RAP) was associated with superior renal function irrespective of the degree of cardiac output.
In patients with advanced HF, high RAP contributed more to impaired GFR than low MAP. A higher RPP was more closely related to GFR than was high cardiac index.
心力衰竭（HF）患者的肾功能障碍传统上归因于心输出量下降和肾脏低灌注。然而，其他中心血液动力学异常也可能导致肾功能受损。本研究评估了右心导管插入术中的侵入性中心血液动力学测量与晚期 HF 中测量的肾小球滤过率（mGFR）之间的关系。
通过 Scandiatransplant 器官交换组织数据库，确定了瑞典在 1988 年至 2019 年间接受心脏移植检查的所有患者。回顾性检索了侵入性血液动力学变量和 mGFR。共有 1001 名受试者（49±13 岁；24%为女性）符合研究条件。协方差分析调整了年龄、性别和中心，结果显示，较高的右心房压（RAP）与 GFR 受损呈最强相关性[β系数-0.59；95%置信区间（CI）-0.69 至-0.48；P<0.001]，其次是较低的平均动脉压（MAP）（β系数 0.29；95%CI 0.14-0.37；P<0.001），最后是降低的心指数（β系数 3.51；95%CI 2.14-4.84；P<0.003）。高 RAP 和低 MAP 的组合与明显更差的 mGFR 相关，而高肾灌注压（MAP 减去 RAP）与肾功能的关系更密切，而与心输出量的程度无关。
在晚期 HF 患者中，高 RAP 对 GFR 的影响大于低 MAP。较高的 RPP 与 GFR 的相关性比高心指数更密切。
