Right ventricular dysfunction is associated with chronic kidney disease and predicts survival in patients with chronic systolic heart failure

Dini, Frank Lloyd; Demmer, Ryan T.; Simioniuc, Anca; Morrone, Doralisa; Donati, Francescamaria; Guarini, G; Orsini, Enrico; Caravelli, Paolo; Marzilli, Mario; Colombo, P.C.

doi:10.1093/eurjhf/hfr176

Cited by 96 publications

(83 citation statements)

References 36 publications

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“…More recent clinical data have focused on venous congestion in heart failure (3), where central venous pressures (CVP), but not cardiac output or pulmonary capillary wedge pressures, are associated with renal dysfunction (4). Consequently, the current concept of the cardiorenal syndrome, typically used to describe renal injury in the setting of poor arterial flow due to left ventricular dysfunction, is being modified to include venous congestion (5)(6)(7)(8)(9) and right ventricular function (10). Whether venous congestion is similarly associated with poor renal outcomes in other populations is not known.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

Chen

Cavender

Lee

et al. 2016

Clinical Journal of the American Society of Nephrology

133

105

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Background and objectives Although venous congestion has been linked to renal dysfunction in heart failure, its significance in a broader context has not been investigated.Design, setting, participants, & measurements Using an inception cohort of 12,778 critically ill adult patients admitted to an urban tertiary medical center between 2001 and 2008, we examined whether the presence of peripheral edema on admission physical examination was associated with an increased risk of AKI within the first 7 days of critical illness. In addition, in those with admission central venous pressure (CVP) measurements, we examined the association of CVPs with subsequent AKI. AKI was defined using the Kidney Disease Improving Global Outcomes criteria.Results Of the 18% (n=2338) of patients with peripheral edema on admission, 27% (n=631) developed AKI, compared with 16% (n=1713) of those without peripheral edema. In a model that included adjustment for comorbidities, severity of illness, and the presence of pulmonary edema, peripheral edema was associated with a 30% higher risk of AKI (95% confidence interval [95% CI], 1.15 to 1.46; P,0.001), whereas pulmonary edema was not significantly related to risk. Peripheral edema was also associated with a 13% higher adjusted risk of a higher AKI stage (95% CI, 1.07 to 1.20; P,0.001). Furthermore, levels of trace, 1+, 2+, and 3+ edema were associated with 34% (95% CI, 1.10 to 1.65), 17% (95% CI, 0.96 to 1.14), 47% (95% CI, 1.18 to 1.83), and 57% (95% CI, 1.07 to 2.31) higher adjusted risk of AKI, respectively, compared with edema-free patients. In the 4761 patients with admission CVP measurements, each 1 cm H 2 O higher CVP was associated with a 2% higher adjusted risk of AKI (95% CI, 1.00 to 1.03; P=0.02).Conclusions Venous congestion, as manifested as either peripheral edema or increased CVP, is directly associated with AKI in critically ill patients. Whether treatment of venous congestion with diuretics can modify this risk will require further study.

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Section: Introductionmentioning

confidence: 99%

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

Chen

Cavender

Lee

et al. 2016

Clinical Journal of the American Society of Nephrology

133

105

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“…In patients with chronic heart failure and impaired function of the LV, a TAPSE ≤ 14 mm predicted all-cause mortality in multivariate analysis [22].…”

Section: Tricuspid Annular Plane Systolic Excursionmentioning

confidence: 99%

Echocardiographic evaluation of right ventricular systolic function: The traditional and innovative approach

Smolarek¹,

Gruchała

Sobiczewski

2017

Cardiol J.

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Estimation of right ventricular (RV) performance still remains technically challenging due to its anatomical and functional distinctiveness. The current guidelines for the echocardiographic quantification of RV function recommend using multiple indices to describe the RV in a thorough and comprehensive manner, such as RV index of myocardial performance, tricuspid annular plane systolic excursion, fractional area change, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'-wave), three-dimensional RV ejection fraction (3D RVEF), RV longitudinal strain (RVLS)/strain rate by speckle-tracking echocardiography (STE). Among these, the last one mentioned here is an innovative and a particularly promising tool that yields more precise information about complex regional and global RV mechanics. STE was initially designed to evaluate left ventricular function, but recently it has been intro-duced to assess RV performance, which is difficult due to its unique structure and physiology. Many studies have shown that both free wall and 6-segment RVLS present a stronger correlation with the RVEF assessed by cardiac magnetic resonance than conventional parameters and seem to be more sensitive in detecting myocardial dysfunction at an earlier, subclinical stage. (Cardiol J 2017; 24, 5: 563-572)

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“…В исследованиях Dini и др. [11] показано, что сер-дечно-сосудистые нарушения являются важным прогностическим фактором плохой выживаемости у пациентов с ХБП, правожелудочковая СН также способствует заболеваемости и смертности. Кроме того, увеличение массы ПЖ было связано со случа-ями СН и сердечно-сосудистой смертности.…”

Section: Introductionunclassified

“…Известно, что ЛЖ берет свое начало от первичной оболочки сердца, тогда как ПЖ возникает из передней части сердца, ЛЖ имеет форму эллипса, тогда как ПЖ тре-угольника. Кроме того, миокард ЛЖ толще и имеет большую массу, чем ПЖ и, следовательно, лучше приспособлен к перегрузке давлением, в то время как более податливый ПЖ лучше переносит пере-грузку объемом [11][12][13]. Показатель систолической экскурсии плоскости три-куспидального кольца (TAPSE), наряду с легочным артериальным давлением (ЛАД), один из широко из-ученных методов допплеровской Эхо-КГ оценки ПЖ и ассоциирован с неблагоприятными исходами [47].…”

Section: Introductionunclassified

“…Так, КРС тип 4, или хронический кардиоренальный синдром, был определен как «хро-нические нарушения функции почек, приводящие к болезни сердца» и подразумевает крайнюю степень риска сердечно-сосудистых заболеваний у больных с хроническими болезнями почек (ХБП) [9,10]. Тем не менее, мало известно относительно того, могут ли специфические почечные расстройства, такие как минеральные и костные нарушения при ХБП (ХБП-МКН), дисфункция эндотелия, задержка жидкости или активац ия ренин-ангиотензиновой (РААС) и нейро-эндокринной системы способствовать дис-функции правого желудочка (ПЖ) [11][12][13]. Исследованиями последних лет установлено, что у пациентов с начальной стадией ХБП, уже реги-стрируются сердечно-сосудистые нарушения, кото-рые в отдаленных этапах развития почечной дис-функции выступают в качестве ведущих причин смертей [14][15][16].…”

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Effect of Renal Dysfunction on the Cardiacvascular System. The Possibili Ties of Early Diagnosis of the Renal Dysfunction

Imanov¹,

Муркамилов²,

Сабиров³

et al. 2018

Arhivʺ vnutr. med.

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The review is devoted to the discussion of modern concepts of the role of renal dysfunction in the development of chronic myocardial dysfunction in the context of cardio-renal syndrome (RVC) type 4. At the beginning of the review, the definition of cattle is given, general questions of pathogenesis and diagnosis of the disease are addressed. It is indicated that in patients with the initial stage of CKD, cardiovascular disorders are already registered which in the late stages of development of renal dysfunction are the leading causes of death and the true severity of the disease in patients with renal dysfunction is associated with an increased risk of cardiovascular events, rather than an achievement terminal renal failure and requiring renal replacement therapy. The progression of renal pathology leads to damage to the heart through various mechanisms and factors, both traditional and non-traditional, some of which, at the culmination of the renal continuum, are the result of the dialysis procedure itself in patients with terminal renal dysfunction. Mechanisms for the development of congestive heart failure in type 4 cattle include pressure overload (arterial hypertension) and volume (anemia, edematous syndrome), which increase in proportion to the decrease in renal function. Increase in blood pressure, changes in intracardial hemodynamics, deterioration of arterial compliance contribute to the acceleration of cardiovascular events. The role of laboratory predictors of renal dysfunction in the progression of cardiovascular disorders is discussed. The general approaches of echocardiographic visualization of the heart cavities and its importance in the diagnosis of cardiovascular diseases are discussed. Special attention is paid to the development of pulmonary arterial hypertension, changes in the left and right ventricle of the myocardium with renal dysfunction.

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Right ventricular dysfunction is associated with chronic kidney disease and predicts survival in patients with chronic systolic heart failure

Cited by 96 publications

References 36 publications

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

Echocardiographic evaluation of right ventricular systolic function: The traditional and innovative approach

Effect of Renal Dysfunction on the Cardiacvascular System. The Possibili Ties of Early Diagnosis of the Renal Dysfunction

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