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Mortality after myocardial infarction: the role of renal function and systolic and diastolic functions of the left ventricle.

Publication ,  Journal Article
Azevedo, REU; Lopes, RD; Canziani, MEF; Gonçalves, I; Campos, PCGD; Vieira, MLC; Stefanini, E; Carvalho, AC
Published in: J Nephrol
2013

BACKGROUND: The relationship between renal dysfunction and mortality after myocardial infarction (MI) has been demonstrated in patients with reduced ejection fraction. The importance of diastolic dysfunction in this scenario is unknown. METHODS: We studied 749 patients with acute MI who were evaluated within 24 hours of symptom onset. The Modification of Diet in Renal Disease equation was used to calculate the estimated glomerular filtration rate (eGFR). Preserved and depressed renal functions were defined as eGFR >60 and <60 mL/min, respectively. Diastolic function was determined by echocardiography and classified as normal or mildly, moderately or severely reduced. The left ventricular systolic function (cutoff of 0.55) was assessed by echocardiography. RESULTS: The mean age of the cohort was 62 years (±13 years); 61.3% were male, 70.2% were hypertensive, 32% were diabetic and 34.8% had hyperlipidemia. Seventy-eight patients died in hospital (10.4%), and 319 (42.6%) had an eGFR <60 mL/min. Diastolic dysfunction was present in 520 (69.4%) patients. Renal function was independently associated with worse in-hospital mortality (adjusted odds ratio 3.12, 95% confidence interval 1.71-5.69, per 10 mL/min 
decrease in eGFR <60 mL/min). For patients with normal-to-moderate diastolic dysfunction, normal renal function was not associated with increased in-hospital mortality (p-interaction = 0.01). CONCLUSIONS: Impaired renal function and both systolic and diastolic dysfunctions were associated with worse in-hospital mortality. However, normal-to-moderate diastolic dysfunction in the presence of normal renal function was not associated with worse outcome. 
Efforts to preserve renal function in patients with acute myocardial infarction should be made, particularly 
in those with diastolic dysfunction.

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Published In

J Nephrol

DOI

EISSN

1724-6059

Publication Date

2013

Volume

26

Issue

6

Start / End Page

1089 / 1096

Location

Italy

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Urology & Nephrology
  • Ultrasonography
  • Time Factors
  • Systole
  • Stroke Volume
  • Renal Insufficiency, Chronic
  • Myocardial Infarction
  • Middle Aged
  • Male
 

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Azevedo, R. E. U., Lopes, R. D., Canziani, M. E. F., Gonçalves, I., Campos, P. C. G. D., Vieira, M. L. C., … Carvalho, A. C. (2013). Mortality after myocardial infarction: the role of renal function and systolic and diastolic functions of the left ventricle. J Nephrol, 26(6), 1089–1096. https://doi.org/10.5301/jn.5000294
Azevedo, Rudyney E. U., Renato D. Lopes, Maria Eugênia F. Canziani, Iran Gonçalves, Paulo Cesar G. D. Campos, Marcelo L. C. Vieira, Edson Stefanini, and Antonio C. Carvalho. “Mortality after myocardial infarction: the role of renal function and systolic and diastolic functions of the left ventricle.J Nephrol 26, no. 6 (2013): 1089–96. https://doi.org/10.5301/jn.5000294.
Azevedo REU, Lopes RD, Canziani MEF, Gonçalves I, Campos PCGD, Vieira MLC, et al. Mortality after myocardial infarction: the role of renal function and systolic and diastolic functions of the left ventricle. J Nephrol. 2013;26(6):1089–96.
Azevedo, Rudyney E. U., et al. “Mortality after myocardial infarction: the role of renal function and systolic and diastolic functions of the left ventricle.J Nephrol, vol. 26, no. 6, 2013, pp. 1089–96. Pubmed, doi:10.5301/jn.5000294.
Azevedo REU, Lopes RD, Canziani MEF, Gonçalves I, Campos PCGD, Vieira MLC, Stefanini E, Carvalho AC. Mortality after myocardial infarction: the role of renal function and systolic and diastolic functions of the left ventricle. J Nephrol. 2013;26(6):1089–1096.
Journal cover image

Published In

J Nephrol

DOI

EISSN

1724-6059

Publication Date

2013

Volume

26

Issue

6

Start / End Page

1089 / 1096

Location

Italy

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Urology & Nephrology
  • Ultrasonography
  • Time Factors
  • Systole
  • Stroke Volume
  • Renal Insufficiency, Chronic
  • Myocardial Infarction
  • Middle Aged
  • Male