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Impaired renal function in patients with ischemic and nonischemic chronic heart failure: association with

Tom D J Smilde1, Hans L Hillege, Gerjan Navis

  • 1Department of Cardiology, Thoraxcenter, University Hospital, Groningen, The Netherlands. t.d.j.smilde@thorax.azg.nl

American Heart Journal
|June 25, 2004
PubMed

Insights

Renal dysfunction strongly predicts mortality in chronic heart failure (CHF). Glomerular filtration rate (GFR) is linked to survival and neurohormones in both ischemic and non-ischemic heart failure patients.

Area of Science:

  • Cardiology
  • Nephrology

Background:

  • Renal dysfunction is a significant predictor of mortality in patients with chronic heart failure (CHF).
  • The relationship between impaired renal function and advanced atherosclerosis in CHF is debated.
  • This study investigated renal function in ischemic versus non-ischemic CHF, examining prognosis and neurohormonal activation.

Purpose of the Study:

  • To compare renal function in patients with ischemic (coronary artery disease - CAD) and non-ischemic (idiopathic dilated cardiomyopathy - IDC) chronic heart failure (CHF).
  • To examine the association between renal function, prognosis, and neurohormonal activation in these patient groups.
  • To determine if the predictive value of renal function differs between ischemic and non-ischemic CHF.

Main Methods:

  • A large survival study included 1906 patients with advanced CHF (New York Heart Association class III-IV).
  • Patients were categorized into coronary artery disease (CAD, n = 995) and idiopathic dilated cardiomyopathy (IDC, n = 429) groups.
  • Glomerular filtration rate (GFR) was calculated using the Cockcroft-Gault equation (GFRc); plasma neurohormones were measured in a substudy.

Main Results:

  • GFRc was a significant predictor of mortality in both CAD and IDC groups.
  • The relative risk of mortality associated with the lowest quartile of GFRc was higher in IDC (3.04) than in CAD (1.81).
  • Plasma neurohormone levels correlated with GFRc in both patient groups.

Conclusions:

  • Glomerular filtration rate (GFRc) is associated with survival and plasma neurohormones in both ischemic (CAD) and non-ischemic (IDC) chronic heart failure (CHF) patients.
  • The association between GFRc, survival, and neurohormonal activation appears to be at least as strong in IDC as in CAD.
  • Impaired renal function is a critical prognostic factor in advanced CHF, irrespective of etiology.
Abstract

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