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Mildly Reduced Renal Function Is Associated With Increased Heart Failure Admissions in Patients With Hypertrophic
Nan Young Bae1, Tae-Min Rhee2, Chan Soon Park1
1Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Even mildly reduced kidney function in hypertrophic cardiomyopathy (HCM) patients significantly increases the risk of major adverse cardiovascular events (MACEs), particularly heart failure hospitalizations.
Area of Science:
- Cardiology
- Nephrology
- Clinical Outcomes Research
Background:
- The link between impaired kidney function and cardiovascular prognosis in hypertrophic cardiomyopathy (HCM) is not well-established.
- This study investigates the association between reduced estimated glomerular filtration rate (eGFR) and adverse cardiovascular outcomes in HCM patients.
Purpose of the Study:
- To determine if mildly reduced renal function is associated with worse prognosis in patients diagnosed with hypertrophic cardiomyopathy.
- To quantify the risk of major adverse cardiovascular events (MACEs) in HCM patients across different stages of kidney function.
Main Methods:
- 1,756 patients with HCM were analyzed, excluding those on dialysis or with prior heart failure or stroke.
- Patients were stratified by eGFR into stage I (≥90), stage II (60-89), and stage III-V (<60 mL/min/1.73 m²).
- Major adverse cardiovascular events (MACEs), including cardiovascular death, heart failure hospitalization (HHF), and stroke, were tracked over a median of 4.0 years using multivariable Cox regression.
Main Results:
- Patients with stage III-V renal function had a 2.71-fold higher risk of MACEs (P=0.003), driven by cardiovascular death and HHF.
- Even stage II renal function (eGFR 60-89 mL/min/1.73 m²) was linked to a 2.21-fold increased MACE risk (P=0.008) and a 2.62-fold higher HHF risk (P=0.012) compared to stage I.
- The findings highlight a significant association between reduced eGFR and adverse cardiovascular outcomes in the HCM cohort.
Conclusions:
- Mildly reduced renal function (eGFR 60-89 mL/min/1.73 m²) in HCM patients is associated with a significantly elevated risk of MACEs.
- Hospitalization for heart failure (HHF) was a primary driver of increased MACEs in patients with reduced renal function.
- These results underscore the importance of monitoring renal function in HCM management for improved cardiovascular risk stratification.
Background:
The association between renal dysfunction and cardiovascular outcomes has yet to be determined in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate whether mildly reduced renal function is associated with the prognosis in patients with HCM.
Methods:
Patients with HCM were enrolled at two tertiary HCM centers. Patients who were on dialysis, or had a previous history of heart failure (HF) or stroke were excluded. Patients were categorized into 3 groups by estimated glomerular filtration rate (eGFR): stage I (eGFR ≥ 90 mL/min/1.73 m², n = 538), stage II (eGFR 60-89 mL/min/1.73 m², n = 953), and stage III-V (eGFR < 60 mL/min/1.73 m², n = 265). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, hospitalization for HF (HHF), or stroke during median 4.0-year follow-up. Multivariable Cox regression model was used to adjust for covariates.
Results:
Among 1,756 HCM patients (mean 61.0 ± 13.4 years; 68.1% men), patients with stage III-V renal function had a significantly higher risk of MACEs (adjusted hazard ratio [aHR], 2.71; 95% confidence interval [CI], 1.39-5.27; P = 0.003), which was largely driven by increased incidence of cardiovascular death and HHF compared to those with stage I renal function. Even in patients with stage II renal function, the risk of MACE (vs. stage I: aHR, 2.21' 95% CI, 1.23-3.96; P = 0.008) and HHF (vs. stage I: aHR, 2.62; 95% CI, 1.23-5.58; P = 0.012) was significantly increased.
Conclusion:
This real-world observation showed that even mildly reduced renal function (i.e., eGFR 60-89 mL/min/1.73 m²) in patients with HCM was associated with an increased risk of MACEs, especially for HHF.
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