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Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure

AIMS: Venous congestion is a major determinant of worsening renal function (WRF) in acute decompensated heart failure (ADHF), particularly when associated with right ventricular (RV) dysfunction. Whether the individual impacts of hemodynamic variables on renal outcomes in ADHF is modified according...

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Autores principales: Bouabdallaoui, Nadia, Beaubien‐Souligny, William, Denault, André Y., Rouleau, Jean L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373894/
https://www.ncbi.nlm.nih.gov/pubmed/32400036
http://dx.doi.org/10.1002/ehf2.12732
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author Bouabdallaoui, Nadia
Beaubien‐Souligny, William
Denault, André Y.
Rouleau, Jean L.
author_facet Bouabdallaoui, Nadia
Beaubien‐Souligny, William
Denault, André Y.
Rouleau, Jean L.
author_sort Bouabdallaoui, Nadia
collection PubMed
description AIMS: Venous congestion is a major determinant of worsening renal function (WRF) in acute decompensated heart failure (ADHF), particularly when associated with right ventricular (RV) dysfunction. Whether the individual impacts of hemodynamic variables on renal outcomes in ADHF is modified according to RV function remains unclear. We aimed to determine the association between hemodynamic parameters and early changes in renal function during depletive therapy and explore the association of these changes with clinical outcomes. METHODS AND RESULTS: WRF was defined as any increase in creatinine after 24 h of depletive therapy and improvement in renal function (IRF) as any decrease. Assessments were prospectively obtained on admission, 24 h later and at discharge. Out of the 105 patients enrolled, 45% had IRF, and 41% had poor RV. At baseline, patients evolving towards IRF had a lower mean arterial pressure (84.7 ± 13.9 vs. 90.9 ± 15.2 mmHg), a lower renal perfusion pressure (69.4 ± 16.2 vs. 75.4 ± 15.1 mmHg), and a poorer RV function (tricuspid annular plan systolic excursion 16.5 ± 6.0 vs. 18.8 ± 5.6 mm) in comparison with those with WRF (all P < 0.05). In a multivariate linear regression model, tricuspid annular plane systolic excursion was the dominant parameter correlated with early changes in creatinine when RV was poor (β = 0.337), whereas mean arterial pressure (β = −0.334) and cardiac output (β = −0.298) were the only parameters correlated with renal function in patients with preserved RV function (all P < 0.05). RV dysfunction, but not early changes in renal function, was associated with post‐discharge clinical events. CONCLUSIONS: RV dysfunction is a predictor of an early but transient progression to IRF during depletive therapy. RV dysfunction modifies the individual impact of various hemodynamic variables on the early trajectory of renal function in ADHF.
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spelling pubmed-73738942020-07-22 Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure Bouabdallaoui, Nadia Beaubien‐Souligny, William Denault, André Y. Rouleau, Jean L. ESC Heart Fail Original Research Articles AIMS: Venous congestion is a major determinant of worsening renal function (WRF) in acute decompensated heart failure (ADHF), particularly when associated with right ventricular (RV) dysfunction. Whether the individual impacts of hemodynamic variables on renal outcomes in ADHF is modified according to RV function remains unclear. We aimed to determine the association between hemodynamic parameters and early changes in renal function during depletive therapy and explore the association of these changes with clinical outcomes. METHODS AND RESULTS: WRF was defined as any increase in creatinine after 24 h of depletive therapy and improvement in renal function (IRF) as any decrease. Assessments were prospectively obtained on admission, 24 h later and at discharge. Out of the 105 patients enrolled, 45% had IRF, and 41% had poor RV. At baseline, patients evolving towards IRF had a lower mean arterial pressure (84.7 ± 13.9 vs. 90.9 ± 15.2 mmHg), a lower renal perfusion pressure (69.4 ± 16.2 vs. 75.4 ± 15.1 mmHg), and a poorer RV function (tricuspid annular plan systolic excursion 16.5 ± 6.0 vs. 18.8 ± 5.6 mm) in comparison with those with WRF (all P < 0.05). In a multivariate linear regression model, tricuspid annular plane systolic excursion was the dominant parameter correlated with early changes in creatinine when RV was poor (β = 0.337), whereas mean arterial pressure (β = −0.334) and cardiac output (β = −0.298) were the only parameters correlated with renal function in patients with preserved RV function (all P < 0.05). RV dysfunction, but not early changes in renal function, was associated with post‐discharge clinical events. CONCLUSIONS: RV dysfunction is a predictor of an early but transient progression to IRF during depletive therapy. RV dysfunction modifies the individual impact of various hemodynamic variables on the early trajectory of renal function in ADHF. John Wiley and Sons Inc. 2020-05-13 /pmc/articles/PMC7373894/ /pubmed/32400036 http://dx.doi.org/10.1002/ehf2.12732 Text en © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research Articles
Bouabdallaoui, Nadia
Beaubien‐Souligny, William
Denault, André Y.
Rouleau, Jean L.
Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure
title Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure
title_full Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure
title_fullStr Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure
title_full_unstemmed Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure
title_short Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure
title_sort impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373894/
https://www.ncbi.nlm.nih.gov/pubmed/32400036
http://dx.doi.org/10.1002/ehf2.12732
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