Dependence of renal filtration capacity on the phenotype of chronic heart failure, indicators of systolic and diastolic heart function

Abstract

The issue of changes in the filtration capacity of the kidneys depending on the structural-geometric and functional remodeling of the heart in different phenotypes of chronic heart failure, disorders of systolic and diastolic function of the left ventricle remains insufficiently studied. The aim of this work: to investigate the relationship between changes in the filtration capacity of the kidneys in patients with chronic heart failure of ischemic genesis depending on the phenotype, indicators of systolic and diastolic cardiac function. Materials and methods. After an informed consent was signed, 87 patients (men – n = 45, women – n = 42) with CHF of ischemic genesis with sinus rhythm, stage II A–B, II–IV functional class NYHA, who were divided into 2 groups, were involved in the study. Group 1 included patients with reduced (<45 %) left ventricular ejection fraction (HFrEF) (n = 57; 59.6 % men), group 2 – patients with CHF with preserved left ventricular ejection fraction (HFpEF) (n = 30; 36.6 % men). Patient groups were comparable in terms of age, sex, height, weight, and body surface area. Doppler echocardiographic examination was performed using the Esaote MyLab Eight (Italy). Glomerular filtration rate (GFR) was assessed using the CKD-EPI, MDRD, and Cockcroft-Gault formulas. Results. Renal dysfunction was registered in patients with CHF in 72 % of cases when calculated using the CKD-EPI formula, 66.7 % using the MDRD formula and 52.6 % using the Cockcroft-Gault formula. Only indicators of blood creatinine level (P = 0.011) and the calculated indicator of glomerular filtration rate according to Cockcroft-Gault (p = 0.047) depended on the types of CHF. GFR for all applied formulas (СKD-EPI, MDRD, Cockcroft-Gault) depended on age (r = -0.42; P = 0.001), height (r = 0.28; P = 0.08), weight (r = 0.31; P = 0.004), body surface area (r = 0.33; P = 0.002). A direct correlation between the creatinine level and the LV myocardial mass index, calculated using the Penn Convention formula, was established, however, the dependence of the creatinine level and GFR on the types of LV geometry was not revealed. The presence of an inverse correlation between LVEF and blood creatinine level (r = -0.3172; P = 0.003), between creatinine content and S lat (r = -0.531; Р = 0.006), a direct correlation between S lat and CKD-EPI (r = 0.5586; P = 0.004), MDRD (r = 0.6254; P = 0.001), Cockcroft-Gault (r = 0.4043; P = 0.045). Conclusions. In chronic heart failure of ischemic genesis with reduced left ventricular ejection fraction, a more pronounced impairment of the filtration capacity of the kidneys than in chronic heart failure patients with preserved left ventricular ejection fraction is observed. An inverse correlation was established between the LV EF and the blood creatinine level (r = -0.3172; P = 0.003). A decrease in the systolic velocity of movement of the lateral annulus fibrosus of the mitral valve is associated with a decrease in the filtration capacity of the kidneys in terms of creatinine level (r = -0.531; P = 0.006), GFR according to the CKD-EPI (r = 0.5586; P = 0.004), MDRD (r = 0.6254; P = 0.001), Cockcroft-Gault (r = 0.4043; P = 0.045) in patients with CHF of ischemic genesis of both phenotypes. In patients with CHF of ischemic genesis of both phenotypes, the myocardial mass index, calculated according to the Penn Convention, correlates with the blood creatinine content (r = 0.95; P = 0.003). In patients with CHF of ischemic genesis, the restrictive type of diastolic filling of the left ventricle is associated with a significant increase in blood creatinine levels by 14 % (P = 0.03) compared with patients with diastolic LV dysfunction by the type of relaxation disorder.