P1487The additive effect of diastolic dysfunction and renal insufficiency on mortality in patients undergoing coronary angiography

Abstract

Background Coronary artery disease (CAD) is the leading cause of diastolic dysfunction. Diastolic dysfunction is associated with adverse outcomes. Renal insufficiency is also associated with adverse outcomes in CAD patients. The interaction between diastolic dysfunction and renal insufficiency is not completely elucidated. Aims We evaluated the prognostic value of diastolic function assessed by echocardiography in patients with and without renal failure undergoing coronary angiography. Patients and methods An observational prospective study of 547 consecutive patients undergoing coronary angiography. The median follow up was 30 months. Significant diastolic dysfunction was defined as elevated LV filling pressure with e/e'>12. Renal insufficiency was defined as adjusted GFR<60 ml/min. One hundred seventy-nine patients (32.7%) had significant diastolic dysfunction and 259 (47.3%) had renal insufficiency. Patients were categorized into 4 groups according to the presence of both significant diastolic dysfunction and renal insufficiency (Table 1). Results Significant diastolic dysfunction and renal insufficiency had additive effect on mortality (Table 1). A significant association was observed between diastolic dysfunction and mortality in patients with and without renal insufficiency (p<0.0001 & p=0.005, respectively). The presence of either diastolic dysfunction or renal insufficiency was associated with mortality (Figure 1), with the combination of both leading to the highest mortality (p<0.0001). In Cox regression model which combined diastolic dysfunction, presence of AF, LVEF, obstructive coronary disease on angiography, presence of acute coronary syndrome and renal insufficiency, both elevated filling pressure and renal insufficiency were independently associated with higher mortality (HR 2.65, CI 1.65–4.24, p<0.001 and HR 2.92, CI 1.72–4.98, p<0.0001, respectively). Table 1. Patients divided into 4 groups according to the presence of the significant diastolic dysfunction and renal insufficiency Patients' group N (%) Mortality Normal LV filling pressure / Normal renal function 230 (42.0%) 4.8% Elevated LV filling pressure / Normal renal function 58 (10.6%) 15.5% Normal LV filling pressure / Renal insufficiency 138 (25.2%) 15.9% Elevated LV filling pressure / Renal insufficiency 121 (22.1%) 38.8% P<0.0001 in Pearson Chi-Square. Fugure 1 Conclusions In patients undergoing coronary angiography, significant diastolic dysfunction with elevated filling pressure is associated with mortality in patients both with and without renal insufficiency. Both significant diastolic dysfunction and renal insufficiency are independent predictors of mortality.

Mitral E‐wave to stroke volume ratio displays stronger diagnostic performance to identify elevated left ventricular filling pressures than mitral E/e’ during passive leg lift: A cross‐sectional study employing simultaneous echocardiography and catheterization

“…Elevated left ventricular (LV) filling pressure is a hallmark of heart failure (HF) and portends poor prognosis. 1 Accurate assessment of LV filling pressure poses a diagnostic challenge irrespective of ejection fraction. 2 Furthermore, HF patients with normal filling pressures at rest often display a disproportionate pressure rise when provoked by exertional maneuvers, which include rapid preload increase during passive leg lift (PLL).…”

“…Elevated left ventricular (LV) filling pressure is a hallmark of heart failure (HF) and portends poor prognosis 1 . Accurate assessment of LV filling pressure poses a diagnostic challenge irrespective of ejection fraction 2 .…”