Heart failure with preserved ejection fraction is the most frequent but commonly overlooked phenotype in patients on chronic hemodialysis.

Autor:	Malik J; 3rd Department of Internal Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia., Valerianova A; 3rd Department of Internal Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia., Pesickova SS; Dialysis Center Ohradni, B. Braun Avitum, Prague, Czechia., Michalickova K; Dialysis Center Taborska, B. Braun Avitum, Prague, Czechia., Hladinova Z; Department of Nephrology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czechia., Hruskova Z; Department of Nephrology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czechia., Bednarova V; Department of Nephrology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czechia., Rocinova K; Dialysis Center Cerny Most, B. Braun Avitum, Prague, Czechia., Tothova M; Dialysis Center Motol, Fresenius Medical Care, Prague, Czechia., Kratochvilova M; Dialysis Center Uhersky Brod, B. Braun Avitum, Uhersky Brod, Czechia., Kaiserova L; 3rd Department of Internal Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia., Buryskova Salajova K; 3rd Department of Internal Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia., Lejsek V; 3rd Department of Internal Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia., Sevcik M; 3rd Department of Internal Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia., Tesar V; Department of Nephrology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czechia.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2023 Jun 01; Vol. 10, pp. 1130618. Date of Electronic Publication: 2023 Jun 01 (Print Publication: 2023).
DOI:	10.3389/fcvm.2023.1130618
Abstrakt:	Introduction: Heart failure (HF) is a serious complication of end-stage kidney disease (ESKD). However, most data come from retrospective studies that included patients on chronic hemodialysis at the time of its initiation. These patients are frequently overhydrated, which significantly influences the echocardiogram findings. The primary aim of this study was to analyze the prevalence of heart failure and its phenotypes. The secondary aims were (1) to describe the potential of N-terminal pro-brain natriuretic peptide (NTproBNP) for HF diagnosis in ESKD patients on hemodialysis, (2) to analyze the frequency of abnormal left ventricular geometry, and (3) to describe the differences between various HF phenotypes in this population. Methods: We included all patients on chronic hemodialysis for at least 3 months from five hemodialysis units who were willing to participate, had no living kidney transplant donor, and had a life expectancy longer than 6 months at the time of inclusion. Detailed echocardiography together with hemodynamic calculations, dialysis arteriovenous fistula flow volume calculation, and basic lab analysis were performed in conditions of clinical stability. Excess of severe overhydration was excluded by clinical examination and by employing bioimpedance. Results: A total of 214 patients aged 66.4 ± 14.6 years were included. HF was diagnosed in 57% of them. Among patients with HF, HF with preserved ejection fraction (HFpEF) was, by far, the most common phenotype and occurred in 35%, while HF with reduced ejection fraction (HFrEF) occurred only in 7%, HF with mildly reduced ejection fraction (HFmrEF) in 7%, and high-output HF in 9%. Patients with HFpEF differed from patients with no HF significantly in the following: they were older (62 ± 14 vs. 70 ± 14, p  = 0.002) and had a higher left ventricular mass index [96(36) vs. 108(45), p  = 0.015], higher left atrial index [33(12) vs. 44(16), p  < 0.0001], and higher estimated central venous pressure [5(4) vs. 6(8), p  = 0.004] and pulmonary artery systolic pressure [31(9) vs. 40(23), p  = 0.006] but slightly lower tricuspid annular plane systolic excursion (TAPSE): 22 ± 5 vs. 24 ± 5, p  = 0.04. NTproBNP had low sensitivity and specificity for diagnosing HF or HFpEF: with the use of the cutoff value of 8,296 ng/L, the sensitivity of HF diagnosis was only 52% while the specificity was 79%. However, NTproBNP levels were significantly related to echocardiographic variables, most significantly to the indexed left atrial volume ( R  = 0.56, p  < 10 -5 ) and to the estimated systolic pulmonary arterial pressure ( R  = 0.50, p  < 10 -5 ). Conclusions: HFpEF was by far the most common heart failure phenotype in patients on chronic hemodialysis and was followed by high-output HF. Patients suffering from HFpEF were older and had not only typical echocardiographic changes but also higher hydration that mirrored increased filling pressures of both ventricles than in those of patients without HF. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 Malik, Valerianova, Pesickova, Michalickova, Hladinova, Hruskova, Bednarova, Rocinova, Tothova, Kratochvilova, Kaiserova, Buryskova Salajova, Lejsek, Sevcik and Tesar.)
Databáze:	MEDLINE
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