Cardiac Structure and Function Among Patients With Heart Failure With Reduced Ejection Fraction and Kidney Disease

BACKGROUND: Kidney disease (KD) is a common comorbidity of heart failure with reduced ejection fraction (HFrEF). In this retrospective study, we sought to investigate measures of cardiac structure and function in relation to prevalent and incident kidney failure in subjects with HFrEF.

METHODS: Subjects with a left ventricular ejection fraction (LVEF) ≤ 45% were included retrospectively from a large HF clinic. Patients were stratified into three groups: (1) no KD at baseline or during follow-up, (2) incident KD during follow-up, (3) prevalent KD. Echocardiographic parameters included LVEF, global longitudinal strain (GLS), tricuspid annular plane systolic excursion (TAPSE), and E/e' ratio. Associations with incident KD were assessed using uni- and multivariable Cox regression.

RESULTS: The final population consisted of 1138 subjects (mean age 68.1 years (SD 11.8), male sex 72.8%), of which 53 (4.7%) had prevalent KD. During a median follow-up period of 9.9 years, 229 (21.1%) of those without KD at baseline developed KD, and the remaining 856 (75.2%) did not. At baseline, LVEF, GLS, TAPSE, and E/e' ratio were incrementally impaired across groups 1 through 3. While all four measures were associated with incident KD in univariable Cox regression, only LVEF (p = 0.023), TAPSE (p = 0.009), and E/e' ratio (p = 0.041) remained significant in adjusted analysis.

CONCLUSION: Among HFrEF patients, future onset of KD and prevalent KD were increasingly associated with impaired GLS, LVEF, TAPSE, and E/e' ratio. Furthermore, LVEF, TAPSE, and E/e' ratio were independent predictors of incident KD.