[Renal dysfunction and mitral regurgitation in patients with chronic heart failure]

The objective of this study was to elucidate the relationship between mitral regurgitation (MR) and the glomerular filtration rate (GFR) in patients with chronic heart failure (CHF). A total of 340 patients with CHF (200 men and 140 women, mean age 58.0 +/- 12.9 years) were included in the study. Arterial hypertension (AH) was the cause of CHF in 44 (13%) patients, coronary heart disease in 112 (33%) patients, and combination of the two disorders in 184 (54%) patients. CHF of functional classes I and II was diagnosed in 112 (33%) and 177 (53%) patients respectively, CHF of functional classes III and IV in 34 (10%) and 17 (5%) patients. GFR was calculated using the MDRD formula. The left ventricular ejection fraction (EF) was 56.9 +/- 10.5%. Systolic dysfunction occurred in 90 (26%) patients and mitral regurgitation in 221 (65%). GFR varied from 19.2 to 149.7 (mean 68.8 +/- 2.9) ml/min/1.73 m2. CRF was below 60 ml/min/1.73 m2 in 114 (34%) patients. There was significant positive correlation between the occurrence of MR and the functional class of CHF (r = 0.35; p < 0.001) while GFR was inversely related to MR (r = -0.43; p < 0.001). Multifactor regression analysis demonstrated that manifestation of MR was associated with the decreased functional activity of the kidneys regardless of the patients" age. It is concluded that changes in the structure of the echo signal from the mitral valve in patients with CHF due to coronary heart disease and/or arterial hypertension are most common in patients with GFR below 60 ml/min/1.73 m2. The degree of MR manifestation is closely associated with the impaired functional activity of the kidneys.