The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction

BACKGROUND: Renal dysfunction in patients with acute myocardial infarction (MI) is an important predictor of short- and long-term outcome. Cardiac abnormalities dominated by left ventricular (LV) hypertrophy are common in patients with chronic renal dysfunction. However, limited data exists on the association between LV systolic- and diastolic function assessed by comprehensive echocardiography and renal dysfunction in contemporary unselected patients with acute MI.

METHODS: We prospectively included 1054 patients with acute MI (mean age 63 years, 73% male) and performed echocardiographic assessment of systolic and diastolic function within 48 hours of admission as well as estimated glomerular filtration rate (eGFR).

RESULTS: Reduced eGFR was significantly associated with LV mass, LV ejection fraction, LV global strain (GLS) and E/e' ratio. After multivariable adjustment, E/e' ratio (P = .0096) remained the only echocardiographic measure independently associated with decreasing eGFR. During follow-up a total of 113 patients (10.7%) patients experienced the composite endpoint of all-cause mortality or hospitalization for heart failure. An eGFR <60 mL/min per 1.73 m(2) was significantly associated with outcome (HR, 1.71; 95% CI, 1.12-2.62; P = .0131) after adjustment for age, diabetes, hypertension, Killip class >1, multivessel disease and troponin. The prognostic impact of an eGFR <60 mL/min per 1.73 m(2) was only modestly altered by addition of LV mass or E/e' ratio whereas addition of LV ejection fraction or GLS attenuated its importance considerably.

CONCLUSION: Renal dysfunction in patients with acute MI is independently associated with echocardiographic evidence of increased LV filling pressure. However, the prognostic importance of renal dysfunction is attenuated to a greater degree by LV longitudinal systolic function.