Mortality after myocardial infarction: the role of renal function and systolic and diastolic functions of the left ventricle

Mortality after myocardial infarction: the role of renal function and systolic and diastolic functions of the left ventricle

Author Azevedol, Rudyney Eduardo Uchoa Autor UNIFESP Google Scholar
Lopes, Renato Delascio Autor UNIFESP Google Scholar
Canziani, Maria Eugenia Fernandes Autor UNIFESP Google Scholar
Goncalves, Iran Autor UNIFESP Google Scholar
Campos, Paulo César Gobert Damasceno Autor UNIFESP Google Scholar
Vieira, Marcelo Luiz Campos Google Scholar
Stefanini, Edson Autor UNIFESP Google Scholar
Carvalho, Antonio Carlos Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Duke Univ
Universidade de São Paulo (USP)
Abstract Background: the relationship between renal dysfunction and mortality after myocardial infarction (MI) has been demonstrated in patients with reduced ejection fraction. the importance of diastolic dysfunction in this scenario is unknown.Methods: We studied 749 patients with acute MI who were evaluated within 24 hours of symptom onset. the Modification of Diet in Renal Disease equation was used to calculate the estimated glomerular filtration rate (eGFR). Preserved and depressed renal functions were defined as eGFR >60 and <60 mL/min, respectively. Diastolic function was determined by echocardiography and classified as normal or mildly, moderately or severely reduced. the left ventricular systolic function (cutoff of 0.55) was assessed by echocardiography.Results: the mean age of the cohort was 62 years (+/- 13 years); 61.3% were male, 70.2% were hypertensive, 32% were diabetic and 34.8% had hyperlipidemia. Seventy-eight patients died in hospital (10.4%), and 319 (42.6%) had an eGFR <60 mL/min. Diastolic dysfunction was present in 520 (69.4%) patients. Renal function was independently associated with worse in-hospital mortality (adjusted odds ratio 3.12, 95% confidence interval 1.71-5.69, per 10 mL/min decrease in eGFR <60 mL/min). for patients with normal-to-moderate diastolic dysfunction, normal renal function was not associated with increased in-hospital mortality (p-interaction = 0.01).Conclusions: Impaired renal function and both systolic and diastolic dysfunctions were associated with worse in-hospital mortality. However, normal-to-moderate diastolic dysfunction in the presence of normal renal function was not associated with worse outcome. Efforts to preserve renal function in patients with acute myocardial infarction should be made, particularly in those with diastolic dysfunction.
Keywords Acute myocardial infarction
Chronic kidney disease
Left ventricular function
Outcomes
Language English
Date 2013-11-01
Published in Journal of Nephrology. Milan: Wichtig Editore, v. 26, n. 6, p. 1089-1096, 2013.
ISSN 1121-8428 (Sherpa/Romeo, impact factor)
Publisher Wichtig Editore
Extent 1089-1096
Origin http://dx.doi.org/10.5301/jn.5000294http://www.sin-italy.org/web/procedure/protocollo.cfm?List=WsIdEvento,WsIdRisposta,WsRelease&c1=00185&c2=16&c3=1
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000331853800016
URI http://repositorio.unifesp.br/handle/11600/36919

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