Prognostic value of echocardiography for heart failure and death in adults with chronic kidney disease.

Autor: Fitzpatrick JK; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA USA., Ambrosy AP; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA USA., Parikh RV; Division of Research, Kaiser Permanente Northern California, Oakland, CA USA., Tan TC; Division of Research, Kaiser Permanente Northern California, Oakland, CA USA., Bansal N; Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA USA., Go AS; Division of Research, Kaiser Permanente Northern California, Oakland, CA USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA USA; Department of Medicine, Stanford University, Palo Alto, CA USA.
Jazyk: angličtina
Zdroj: American heart journal [Am Heart J] 2022 Jun; Vol. 248, pp. 84-96. Date of Electronic Publication: 2022 Mar 10.
DOI: 10.1016/j.ahj.2022.02.001
Abstrakt: Background: Adults with chronic kidney disease (CKD) are at increased risk of heart failure (HF) morbidity and mortality. Despite well-characterized abnormalities in cardiac structure in CKD, it remains unclear how to optimally leverage echocardiography to risk stratify CKD patients.
Methods: We evaluated associations between echocardiographic parameters and risk of HF hospitalization and death using Cox proportional hazard models and forward selection with integrated discrimination improvement (IDI).
Results: The study included 3,505 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. Mean age was 59 ± 11 years, HF prevalence was 10%, and mean left ventricular (LV) ejection fraction (LVEF) was 54 ± 9%. During median 11 (interquartile range: 8-12) years of follow-up, event rates per 100-person years for HF hospitalizations and death, respectively, were 9.4 (95% Confidence Interval [CI]: 7.9-11.3) and 8.9 (95% CI: 7.6-10.5) for participants with LVEF <40%, 3.5 (95% CI: 3.0-4.2) and 4.6 (95% CI: 4.0-5.2) for patients with LVEF 40% to 49%, and 1.9 (95% CI: 1.7-2.1) and 3.1 (95% CI: 2.9-3.3) for patients with LVEF >50%. The rate of HF hospitalizations and deaths increased with lower eGFR across all LVEF categories. LV mass index, LVEF, and LV geometry had the strongest association with outcomes but provided modest incremental prognostic value to a baseline clinical model (IDI = 0.14 and ΔAUC = 0.017 for HF hospitalization, IDI = 0.12 and ΔAUC = 0.008 for death).
Conclusions: Baseline echocardiographic parameters are independently associated with increased risk of subsequent HF morbidity and mortality but provide only marginal incremental prognostic utility beyond clinical characteristics in the setting of CKD.
Competing Interests: Disclosures APA is supported by a Mentored Patient-Oriented Research Career Development Award (K23HL150159) through the National Heart, Lung, and Blood Institute, has received relevant research support through grants to his institution from Amarin Pharma, Inc., Abbott, and Novartis, and modest reimbursement for travel from Novartis. ASG has received relevant research support through grants to his institution from the National Institute of Diabetes, Digestive and Kidney Diseases; National Heart, Lung and Blood Institute; National Institute on Aging; Amarin Pharma, Inc.; Novartis; Janssen Research & Development; and CSL Behring. All other authors have no relevant conflicts of interest to declare.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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