Cardiorenal syndrome in heart failure with preserved ejection fraction—an under-recognized clinical entity

Agrawal, Akanksha; Naranjo, Mario; Kanjanahattakij, Napatt; Rangaswami, Janani; Gupta, Shuchita

doi:10.1007/s10741-018-09768-9

Cited by 34 publications

(44 citation statements)

References 98 publications

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“…Patients had higher BMI, more prevalence of both dyslipidemia and ischaemic aetiology, and all subgroups were similar in terms of impaired renal function and haemoglobin below 12 g/dL. We might hypothesise about the presence of a cardiorenal anaemia syndrome in this population, derived from an interaction between diabetic microvascular disease affecting the kidneys and myocardium, 20 and other factors such as elevated central venous and intra‐abdominal pressure, left ventricular hypertrophy, left ventricular strain, RAAS activation, oxidative injury, pulmonary hypertension and right ventricular dysfunction 21 . Additionally, it should be noted that AF/flutter can form a separate cluster (cluster 4), very similar to cluster 1 except for the presence of these arrhythmias and older age.…”

Section: Discussionmentioning

confidence: 83%

Comorbidities and their implications in patients with and without type 2 diabetes mellitus and heart failure with preserved ejection fraction. Findings from the rica registry

et al. 2020

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Aim To determine if patients with heart failure and preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) have a higher comorbidity burden than those without T2DM, if other comorbidities are preferentially associated with T2DM and if these conditions confer a worse patient prognosis. Methods and results Cohort study based on the RICA Spanish Heart Failure Registry, a multicentre, prospective registry that enrols patients admitted for decompensated HF and follows them for 1 year. We selected only patients with HFpEF, classified as having or not having T2DM and performed an agglomerative hierarchical clustering based on variables such as the presence of arrhythmia, chronic obstructive pulmonary disease, dyslipidemia, liver disease, stroke, dementia, body mass index, haemoglobin levels, estimated glomerular filtration rate and systolic blood pressure. A total of 1934 patients were analysed: 907 had T2DM (mean age 78.4 ± 7.6 years) and 1027 did not (mean age 81.4 ± 7.6 years). The analysis resulted in four clusters in patients with T2DM and three in the reminder. All clusters of patients with T2DM showed higher BMI and more kidney disease and anaemia than those without T2DM. Clusters of patients without T2DM had neither significantly better nor worse outcomes. However, among the T2DM patients, clusters 2, 3 and 4 all had significantly poorer outcomes, the worst being cluster 3 (HR 2.0, 95% CI 1.36‐2.93, P = .001). Conclusions Grouping our patients with HFpEF and T2DM into clusters based on comorbidities revealed a greater disease burden and prognostic implications associated with the T2DM phenotype, compared with those without T2DM.

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Section: Discussionmentioning

confidence: 83%

Comorbidities and their implications in patients with and without type 2 diabetes mellitus and heart failure with preserved ejection fraction. Findings from the rica registry

et al. 2020

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“…Likewise, provided that the measurement of PV will be eventually established in clinical settings, large population studies might buttress the present findings and contrast different HFpEF phenotypes (particularly those primarily affected by fluid dysregulation) (Agrawal et al, 2019), comorbidities and the potential influence of different HF therapies on BV status. First, findings were obtained from a moderate sample size of stable HFpEF patients and HC individuals, mainly males.…”

Section: Limitationsmentioning

confidence: 74%

“…Given that HFpEF is more prevalent in females than males, further studies may focus on females, which as a matter of fact present with lower PV compared with males . Likewise, provided that the measurement of PV will be eventually established in clinical settings, large population studies might buttress the present findings and contrast different HFpEF phenotypes (particularly those primarily affected by fluid dysregulation) (Agrawal et al, 2019), comorbidities and the potential influence of different HF therapies on BV status. In this regard, the narrow range of variability of comorbidities and medication in our cohort, although representative of the current HFpEF population (Ponikowski et al, 2016), limits the possibility to assess their specific impact on PV.…”

Section: Limitationsmentioning

confidence: 74%

Relationship between plasma volume and essential blood constituents in patients with heart failure and preserved ejection fraction

Díaz-Cañestro

Haider

Lundby

et al. 2019

Clin Physio Funct Imaging

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Introduction Notwithstanding recent progress on molecular mechanisms underlying heart failure with preserved ejection fraction (HFpEF), multiple pathophysiological aspects of this condition including the basis of anaemia and other haematological disorders remain unresolved. In this study, we sought to determine the relationship of plasma volume (PV), a plausible confounding factor for the concentration of solutes in blood, with key haematological markers in HFpEF patients. Methods Total circulating PV was determined with high precision, automated carbon monoxide rebreathing in 24 stable HFpEF patients (70 AE 8 years, left ventricular ejection fraction = 55AE5%) and 18 healthy age-and sex-matched control (HC) individuals. Linear regression analyses were performed to determine the association of PV with a comprehensive set of haematological variables. Results Haematocrit (40Á1 AE 4Á9 versus 43Á6 AE 2Á7%, P = 0Á004) and haemoglobin concentration (131 AE 16 versus 142 AE 7 g l À1 , P = 0Á003) were reduced in HFpEF patients compared with HC individuals. In regression analyses, PV was negatively associated with haematocrit (r = À0Á45, P = 0Á029) and haemoglobin concentration (r = À0Á44, P = 0Á030) in HFpEF patients, whereas these variables were not associated with PV in HC individuals (P≥0Á198). Regarding blood electrolytes, PV was negatively associated with K + (r = À0Á43, P = 0Á036) and Ca 2+ (r = À0Á44, P = 0Á032) in HFpEF patients but not in HC individuals (P≥0Á734). None of the above associations were detected in HFpEF patients when using ideal instead of measured PV. Conclusion The blood concentration of routine markers of anaemia and electrolyte balance is specifically and linearly associated with PV in HFpEF patients. Excess or deficit of circulating PV may confound clinical diagnosis in this population.

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“…[1][2][3] CHF is a syndrome in which the heart does not provide sufficient blood circulation to meet the metabolic needs of the body, it accompanies almost all heart diseases. [4,5] CKD is a syndrome resulting from an irreversible progressive decrease in renal function due to a decrease in the mass of functioning parenchyma concomitant with metabolic disorders and further development of pathology of a number of organs and systems. [6][7][8][9] Modern medicine emphasizes the bi-directional nature of cardio-renal interaction and extensive interconnected disorders; the heart and kidneys, acting in tandem, regulate blood pressure, vascular tone, diuresis, natriuresis, intravascular volume homeostasis, peripheral tissue perfusion and oxygenation.…”

Section: Introductionmentioning

confidence: 99%

Biochemical parameters of rat blood in the models of chronic heart failure and chronic kidney disease at the administration of nitric oxide donor

2020

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In modern veterinary medicine, the simultaneous occurrence of chronic heart failure and chronic kidney disease is often found. However, the cause and effect often exchange places, which creates great difficulties in the animals’ treatment. Chlofusan acts on both systems. It improves cardiac and renal functions by means of providing cardioprotective and nephroprotective effects. Models of chronic heart failure and chronic kidney disease in rats provide important information on the pathophysiology of these diseases in other animal species, and the assessment of changes in the biochemical analysis of blood makes it possible to assess the state of the heart and kidneys in the study. In the course of research, the results of rat biochemical analysis were studied on models of chronic heart and kidney failure with the introduction of an exogenous nitric oxide donor. Chlofuzan contributes to a partial balance restoration of biochemical blood parameters in rats, which indicates the restoration of the mutual work of the heart and kidneys.

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Cardiorenal syndrome in heart failure with preserved ejection fraction—an under-recognized clinical entity

Cited by 34 publications

References 98 publications

Comorbidities and their implications in patients with and without type 2 diabetes mellitus and heart failure with preserved ejection fraction. Findings from the rica registry

Comorbidities and their implications in patients with and without type 2 diabetes mellitus and heart failure with preserved ejection fraction. Findings from the rica registry

Relationship between plasma volume and essential blood constituents in patients with heart failure and preserved ejection fraction

Biochemical parameters of rat blood in the models of chronic heart failure and chronic kidney disease at the administration of nitric oxide donor

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