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Published on: July 14, 2021
Impact of Renal Function on Myocardial Remodeling and Outcomes in Patients With Moderate Aortic Stenosis
Hyun-Jung Lee1, Kyu Kim1, Seo-Yeon Gwak1
1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Renal dysfunction in moderate aortic stenosis patients is linked to worse heart remodeling and outcomes, independent of valve disease severity. This highlights the impact of comorbidities on cardiac health and prognosis.
Area of Science:
- Cardiology
- Nephrology
- Cardiovascular Research
Background:
- Moderate aortic stenosis (AS) patients with cardiac damage face poor prognosis.
- Comorbidities like chronic kidney disease (CKD) can worsen myocardial damage and outcomes in AS.
- Investigating renal function's impact on myocardial remodeling and outcomes in moderate AS is crucial.
Purpose of the Study:
- To determine the effect of renal function on myocardial remodeling in moderate AS patients.
- To assess the association between chronic kidney disease (CKD) stage and cardiac outcomes in moderate AS.
- To understand if renal dysfunction independently affects prognosis in moderate aortic stenosis.
Main Methods:
- Included 865 moderate AS patients (2008-2020) categorized by CKD stage (eGFR).
- Assessed echocardiographic measures of myocardial remodeling (hypertrophy, function, strain).
- Evaluated composite outcome of all-cause mortality and heart failure hospitalization over 4.0 years.
Main Results:
- Higher CKD stage correlated with increased valvuloarterial impedance and adverse LV remodeling (hypertrophy, diastolic dysfunction, reduced strain).
- Severe CKD (stage 4-5) and myocardial dysfunction independently predicted poor outcomes, even after adjusting for AS severity and interventions.
- Myocardial dysfunction partially mediated the negative impact of renal dysfunction on patient outcomes.
Conclusions:
- Renal dysfunction is independently linked to adverse myocardial remodeling and dysfunction in moderate AS, regardless of valvular hemodynamics.
- Comorbidities like CKD significantly impact cardiac remodeling and prognosis in AS patients.
- Further research is needed on early interventions for AS patients with cardiac damage driven by comorbidities.
Background:
Patients with moderate aortic stenosis (AS) and cardiac damage have poor prognosis, and whether early aortic valve replacement benefits these patients is under investigation. However, besides valvular hemodynamics, comorbidities such as chronic kidney disease (CKD) can contribute to myocardial damage and affect prognosis. The aim of this study was to investigate the impact of renal function on myocardial remodeling and outcomes in patients with moderate AS.
Methods:
The study cohort included 865 consecutive patients diagnosed with moderate AS (aortic valve area > 1.0 and ≤1.5 cm2, mean gradient > 20 mmHg) between 2008 and 2020. Patients were categorized into five stages of CKD according to estimated glomerular filtration rate. Echocardiographic measures of myocardial remodeling and the composite outcome of all-cause mortality and heart failure hospitalization were assessed.
Results:
Higher CKD stage was associated with greater valvuloarterial impedance, as well as greater left ventricular (LV) hypertrophy, worse LV diastolic function, and lower LV and left atrial strain, despite similar AS severity. These associations were independent of age, sex, comorbidities, and LV pressure overload. During a median follow-up period of 4.0 years, 310 composite outcome events (39.3%) occurred, including 258 deaths (32.7%). Severe CKD (stage 4 or 5) and myocardial dysfunction were independent predictors of the composite outcome, after adjustment for key clinical variables including aortic valve replacement. Mediation analysis showed that myocardial dysfunction partially mediated the impact of renal function on outcome.
Conclusions:
In patients with moderate AS, renal dysfunction was independently associated with adverse myocardial remodeling and dysfunction, irrespective of valvular hemodynamics. The role of earlier intervention in patients with moderate AS whose cardiac damage is driven by comorbidities, rather than AS itself, warrants further investigation.
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