The Impact of Aortic Pulsatile Hemodynamics on Renal Function Trajectories in Acute Heart Failure.

Abstract

Background: Perturbation of aortic pulsatile hemodynamics and the presence of impaired renal function (IRF) may increase post-discharge events in patients hospitalized for acute heart failure (AHF). The present study investigated whether on-admission aortic pulsatile hemodynamics is associated with IRF and in-hospital changes in renal function, and modulates its impact on post-discharge adverse events in patients with AHF.

Methods: A total of 240 AHF patients (69.3±15.6 years, 76.7% men) were enrolled and followed for outcomes of heart failure hospitalization and death up to 3 years after discharge. Measures of renal function and aortic pulsatile hemodynamics, including carotid-femoral pulse wave velocity (cf-PWV) and the amplitude of the reflected wave (Pb), were obtained within 24 hours of admission and before discharge. IRF was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m².

Results: On admission, 159 patients (66.3%) presented with IRF. At discharge, eGFR significantly improved by 6.6±13.4 mL/min/1.73m² (19.3±44.7%, P<0.001) in patients with on-admission IRF. Increased on-admission aortic pulsatile hemodynamics was significantly associated with the presence of IRF and inversely associated with the in-hospital improvement of eGFR. Persistent IRF on both admission and discharge (hazard ratio 1.579, 95% confidence interval 1.078-2.315), change of eGFR per 1 standard deviation increment (0.747, 0.597-0.934), and over 30% improvement of eGFR (0.492, 0.306-0.792) were significantly predictive of post-discharge events in multivariable Cox models incorporating either cf-PWV or Pb.

Conclusions: On-admission aortic pulsatile hemodynamics was significantly associated with IRF and in-hospital changes in renal function in patients with AHF, and both were significantly associated with post-discharge adverse events independent of aortic pulsatile hemodynamics.