Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Cardiorenal Med. 2023;13(1):271-281. doi: 10.1159/000533589. Epub 2023 Aug 21.
Impaired relaxation is the earliest manifestation of ischemic cascade. Risk factors and renal function abnormalities are associated with coronary disease and diastolic dysfunction as well. We aimed to study the association of noninvasive assessment of left ventricular filling pressures and renal function with mortality in high-risk patients undergoing coronary angiography.
An observational prospective study of 564 consecutive patients undergoing coronary angiography was conducted. The median follow-up was 2,293 days. Patients were categorized into 2 groups according to presence of significant diastolic dysfunction: group 1, 382 patients, with normal and group 2, 182 patients, with elevated filling pressure. Renal insufficiency was determined as calculated glomerular filtration rate <60 mL/min. Patients demographic, clinical, echocardiography, laboratory, and angiographic data were prospectively collected.
Fifty-three percent of patients underwent angiography due to acute coronary syndrome (ACS), 85.5% had coronary artery disease, 53.4% had reduced (<50%) left ventricular ejection fraction (LVEF), and 47.4% had abnormal renal function. The mortality during the follow-up period was 30.0%. Patients with elevated filling pressure had significantly higher mortality (50.5% vs. 20.2%, p < 0.0001). Impaired renal failure as well, was associated with higher mortality (48% vs. 15%, p < 0.001). The association remained significant in subgroups of patients with and without ACS and reduced and preserved LVEF. In Cox regression model which combined elevated filling pressure, renal insufficiency, age, diabetes mellitus, hypertension, presence of atrial fibrillation, LVEF, and anemia, elevated filling pressure and renal function impairment were independently associated with higher mortality (HR: 3.717, CI: 1.623-8.475, p < 0.0001 and HR: 0.972, CI: 0.958-0.985, p = 0.0001, respectively). There was an incremental prognostic value of elevated filling pressures and renal function impairment on mortality.
Advanced diastolic dysfunction and impaired renal function are signals toward worse outcomes and are associated with mortality in high-risk patients undergoing coronary angiography.
舒张功能障碍是缺血级联反应的最早表现。危险因素和肾功能异常与冠心病和舒张功能障碍也有关。我们旨在研究无创评估左心室充盈压和肾功能与接受冠状动脉造影的高危患者死亡率之间的关系。
对 564 例连续接受冠状动脉造影的患者进行了一项观察性前瞻性研究。中位随访时间为 2293 天。根据是否存在显著舒张功能障碍，患者分为 2 组：组 1，382 例，正常；组 2，182 例，充盈压升高。肾功能不全定义为估算肾小球滤过率＜60mL/min。前瞻性收集患者的人口统计学、临床、超声心动图、实验室和血管造影数据。
53%的患者因急性冠脉综合征（ACS）接受了血管造影，85.5%有冠状动脉疾病，53.4%有左心室射血分数（LVEF）降低（＜50%），47.4%有肾功能异常。随访期间的死亡率为 30.0%。充盈压升高的患者死亡率显著更高（50.5% vs. 20.2%，p＜0.0001）。肾功能衰竭同样与更高的死亡率相关（48% vs. 15%，p＜0.001）。在 ACS 患者和无 ACS 患者、LVEF 降低和保留的患者亚组中，这种相关性仍然显著。在 Cox 回归模型中，将升高的充盈压、肾功能不全、年龄、糖尿病、高血压、心房颤动、LVEF 和贫血结合起来，升高的充盈压和肾功能损害与更高的死亡率独立相关（HR：3.717，CI：1.623-8.475，p＜0.0001 和 HR：0.972，CI：0.958-0.985，p=0.0001）。升高的充盈压和肾功能损害对死亡率有递增的预后价值。
高级舒张功能障碍和肾功能不全是预后不良的信号，与接受冠状动脉造影的高危患者的死亡率相关。
