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Impaired filtration and tubular kidney functions in patients with chronic heart failure with a moderately reduced left ventricular ejection fraction and persistent atrial fibrillation

Session Poster Session 3

Speaker Natalia Koziolova

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : N Koziolova (Perm,RU), S Mironova (Perm,RU), E Polyanskaya (Perm,RU)

Authors:
N Koziolova1 , S Mironova1 , E Polyanskaya1 , 1Perm Medical University - Perm - Russian Federation ,

Citation:

Objective: To evaluate the filtration and tubular kidney functions in patients with chronic heart failure (CHF) with a moderately reduced left ventricular ejection fraction and a persistent form of atrial fibrillation (AF).

Materials and methods: The study included 48 patients with a moderately reduced left ventricular ejection fraction (mrLVEF), which were divided into 2 groups depending on a heart rhythm disorder. The first group included 28 patients with persistent AF, the second one - 20 patients with sinus rhythm. The diagnosis of CHF with a moderately reduced LV EF was confirmed by the presence of LV EF in the range of 40ā€“49%. Diastolic dysfunction was diagnosed according to tissue visualization of diastolic velocity of the mitral valve fibrous ring and an increase in the concentration of the N-terminal fragment of brain natriuretic peptide (NT-proBNP) in the blood using ELISA.To assess the filtration function of the kidneys, serum creatinine, cystatin C concentrations in the blood, glomerular filtration rate (eGFR) were calculated using the CKD-EPI formula for creatinine and cystatin C. Serum Neutrophil gelatinase-associated lipocalin (NGAL) was determined to detect early tubular kidney damage.

Results: the groups did not differ in sex, age, comorbidity, therapy (except for anticoagulants and antiarrhythmic agents), severity of CHF. Indicators of diastolic LV function differed statistically significantly between groups: in the first group, septal e ā€™(p = 0.007), lateral eā€™ (p <0.001), E / e ā€™(p = 0.001) were higher than in the second group. There were no statistically significant differences in serum creatinine and creatinine-based eGFR (p = 0.107 and p = 0.143, respectively) between the groups.

Cystatin C in the blood in the first group was statistically significantly higher than in the second group: 2.7 [2.3; 3.2] ng / ml versus 1.6 [1.3; 3.0] ng / ml (p = 0.019). Cystatin-based eGFR was statistically significantly lower in the first group than in the second (p = 0.019). A statistically significantly higher level of NGAL in the 1st group was noted - 1.8 [1.0; 2.9] ng / ml compared with the 2nd group - 0.6 [0.5; 0.8] ng / ml (p <0.001). A correlation analysis revealed a direct, strong interconnection between the concentration of cystatin C in the blood and E/e'(r = 0.723, p <0.05), a direct moderate interconnection between NGAL levels and E/e' (r = 0.419, p < 0.05). Conclusion: the presence of a persistent AF in CHF patients with moderately reduced LV EF contributes negatively to the formation of cardio-renal syndrome and tubular dysfunction due to more severe LV diastolic dysfunction compared with CHF patients who have sinus rhythm.

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