TY - JOUR
T1 - Wall motion index, estimated glomerular filtration rate and mortality risk in patients with heart failure or myocardial infarction
T2 - a pooled analysis of 18,010 patients
AU - Schou, Morten
AU - Torp-Pedersen, Christian
AU - Gustafsson, Finn
AU - Abdulla, Jawdat
AU - Kober, Lars
PY - 2008/7
Y1 - 2008/7
N2 - AIMS: This study was designed to assess whether the prognostic significance of estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF) interact in populations with heart failure (HF) and myocardial infarction (MI).METHODS: Patients were recruited from four screening registers (N=18,010) including patients admitted with HF or MI. Ten years follow-up was recorded and formal testing for interactions between eGFR and LVEF with respect to outcome was done.RESULTS: Twelve-thousand-and-ninety patients died. A significant interaction (P=0.010) was found and each parameter became relatively more important when the value of the other was low. eGFR and LVEF were reparameterized to categorical variables and we observed that chronic kidney disease stage II was associated with a decreased (Hazard ratio (HR): 0.79 (95% Confidence Interval: 0.72-0.86)) and chronic kidney disease stages IV (HR: 1.60 (1.45-1.91) and V (HR: 1.91 (1.45-2.52) were associated with an increased mortality risk with an additive effect of left ventricular systolic dysfunction (LVSD).CONCLUSION: The prognostic significance of eGFR and LVEF is synergistic in patients with HF or MI and the impact of one parameter is inversely related to the level of the other. Statistical interactions are scale dependent and the relationship between chronic kidney disease stages I to V and mortality risk is J-shaped with an additive effect of LVSD.
AB - AIMS: This study was designed to assess whether the prognostic significance of estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF) interact in populations with heart failure (HF) and myocardial infarction (MI).METHODS: Patients were recruited from four screening registers (N=18,010) including patients admitted with HF or MI. Ten years follow-up was recorded and formal testing for interactions between eGFR and LVEF with respect to outcome was done.RESULTS: Twelve-thousand-and-ninety patients died. A significant interaction (P=0.010) was found and each parameter became relatively more important when the value of the other was low. eGFR and LVEF were reparameterized to categorical variables and we observed that chronic kidney disease stage II was associated with a decreased (Hazard ratio (HR): 0.79 (95% Confidence Interval: 0.72-0.86)) and chronic kidney disease stages IV (HR: 1.60 (1.45-1.91) and V (HR: 1.91 (1.45-2.52) were associated with an increased mortality risk with an additive effect of left ventricular systolic dysfunction (LVSD).CONCLUSION: The prognostic significance of eGFR and LVEF is synergistic in patients with HF or MI and the impact of one parameter is inversely related to the level of the other. Statistical interactions are scale dependent and the relationship between chronic kidney disease stages I to V and mortality risk is J-shaped with an additive effect of LVSD.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Chi-Square Distribution
KW - Denmark/epidemiology
KW - Female
KW - Glomerular Filtration Rate
KW - Heart Failure/mortality
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/mortality
KW - Predictive Value of Tests
KW - Prognosis
KW - Proportional Hazards Models
KW - Registries
KW - Risk
KW - Statistics, Nonparametric
KW - Stroke Volume/physiology
U2 - 10.1016/j.ejheart.2008.04.006
DO - 10.1016/j.ejheart.2008.04.006
M3 - Journal article
C2 - 18565790
SN - 1388-9842
VL - 10
SP - 682
EP - 688
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 7
ER -