Document Detail


Effect of right ventricular function and venous congestion on cardiorenal interactions during the treatment of decompensated heart failure.
MedLine Citation:
PMID:  20152246     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Recent reports have demonstrated the adverse effects of venous congestion on renal function (RF) and challenged the assumption that worsening RF is driven by decreased cardiac output (CO). We hypothesized that diuresis in patients with right ventricular (RV) dysfunction, despite decreased CO, would lead to a decrease in venous congestion and resultant improvement in RF. We reviewed consecutive admissions with a discharge diagnosis of heart failure. RV function was assessed by multiple echocardiographic methods and those with >or=2 measurements of RV dysfunction were considered to have significant RV dysfunction. Worsening RF was defined as an increase in creatinine of >or=0.3 mg/dl and improved RF as improvement in glomerular filtration rate >or=25%. A total of 141 admissions met eligibility criteria; 34% developed worsening RF. Venous congestion was more common in those with RV dysfunction (odds ratio [OR] 3.3, p = 0.009). All measurements of RV dysfunction excluding RV dilation correlated with CO (p <0.05). Significant RV dysfunction predicted a lower incidence of worsening RF (OR 0.21, p <0.001) and a higher incidence of improved RF (OR 6.4, p <0.001). CO emerged as a significant predictor of change in glomerular filtration rate during hospitalization in those without significant RV dysfunction (r = 0.38, p <0.001). In conclusion, RV dysfunction is a strong predictor of improved renal outcomes in patients with acute decompensated heart failure, an effect likely mediated by relief of venous congestion.
Authors:
Jeffrey M Testani; Amit V Khera; Martin G St John Sutton; Martin G Keane; Susan E Wiegers; Richard P Shannon; James N Kirkpatrick
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Publication Detail:
Type:  Journal Article     Date:  2010-01-05
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-15     Completed Date:  2010-03-19     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  511-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood
Cardiac Output, Low / physiopathology
Cohort Studies
Creatinine / blood
Diuretics / therapeutic use
Female
Glomerular Filtration Rate / drug effects
Heart Failure / blood,  complications,  physiopathology*,  therapy,  ultrasonography
Hospitals, University
Humans
Hyperemia / blood,  physiopathology*,  therapy,  ultrasonography
Incidence
Kidney Diseases / complications,  physiopathology*,  therapy,  ultrasonography
Kidney Function Tests
Length of Stay
Male
Middle Aged
Natriuretic Peptide, Brain / blood
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Ventricular Dysfunction, Right / blood,  physiopathology*,  therapy,  ultrasonography
Grant Support
ID/Acronym/Agency:
T32 HL007843/HL/NHLBI NIH HHS; T32 HL007843-15/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Diuretics; 114471-18-0/Natriuretic Peptide, Brain; AYI8EX34EU/Creatinine
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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