Predictors of adverse events in patients with ischemic chronic heart failure with reduced ejection fraction and renal dysfunction

Authors

  • D. A. Lashkul Zaporizhzhia State Medical University,

DOI:

https://doi.org/10.14739/2310-1210.2016.3.76914

Keywords:

Heart Failure, Predictors, Kidney

Abstract

Chronic heart failure (CHF) is one of the most significant health, economic and social problems of the XXI century.

Aim. To identify predictors of adverse events in patients with ischemic chronic heart failure with reduced ejection fraction and renal dysfunction taking into account the results of three years observation.

Materials and methods. In order to reveal prognostic factors of adverse events, 140 patients (81.4% men, mean age 60 (54.5–68) years) with ischemic chronic heart failure with reduced ejection fraction and renal dysfunction were investigated. For determination of dependent and independent prognostic factors of adverse events ROC-analysis, univariate and multivariate Cox proportional hazard regression analyses were done.

Results. In order to determine independent predictors of major adverse cardiovascular events 18 hazards indicators were analyzed using Cox proportional. By results of multivariate regression analysis Cox proportional hazards found that the optimal cut-off point in excess distribution age>65 years, the risk of cumulative endpoint in patients with ischemic heart failure significantly increased in 2.75 times (95% CI 1.67–4.50; p=0.001), heart rate>79 beats minute – in 2.26 times (95% CI 1.32–3.87, p=0.002) and the presence of lower than optimal point distribution values SAP≤140 mmHg – the risk is increased 1.83-fold (95% CI 1.02–3.64, p=0.03), eGFR≤70.27 ml/min/1,73m2 – at 1.73 times (95% CI 1.09–2.75; p=0.02), EF≤34,23% – to 1.94 times (95% CI 1.21–3.11, p=0.005), HDL≤0.86 mmol/l – 1.83 times (95% CI 1.12–2.99, p=0.01).

Conclusion. It was revealed that in patients with ischemic chronic heart failure with reduced ejection fraction and renal dysfunction within three years of observation there are such independent predictors of adverse cardiovascular events as age, heart rate, systolic blood pressure, glomerular filtration rate, left ventricular ejection fraction and HDL levels.

References

Ponikowski, P., Voors, A., Anker, S., Bueno, H., Cleland, J., Coats, A. et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 37(27), 2129–2200.

Go, A., Chertow, G., Fan, D., McCulloch, C., & Hsu, C. (2004). Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. ACC Current Journal Review, 13(12), 13. doi: http://dx.doi.org/10.1016/j.accreview.2004.11.016.

Herzog, C. (2010). Kidney disease in cardiology. Nephrology Dialysis Transplantation, 25(2), 356–360.

Voronkov, L. G., Amosova, K. M., Bahrii, A. E., Dziak, H. V., Diadyk, O. I., Zharinov, O. Y., et al. (2012). Rekomendatsii z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti [Guidelines for the diagnosis and treatment of chronic heart failure]. Sertseva nedostatnist, 3, 60–96 [in Ukrainian].

Takada, T., Sakata, Y., Miyata, S., Takahashi, J., Nochioka, K., Miura, M. et al. (2014). Impact of elevated heart rate on clinical outcomes in patients with heart failure with reduced and preserved ejection fraction: a report from the CHART-2 Study. Eur J Heart Fail, 16(3), 309–316. doi: 10.1002/ejhf.22.

Lip, G., Laroche, C., Popescu, M., Rasmussen, L., Vitali-Serdoz, L., & Dan, G. et al. (2015). Heart failure in patients with atrial fibrillation in Europe: a report from the EURObservational Research Programme Pilot survey on Atrial Fibrillation. Eur J Heart Fail, 17(6), 570–582. doi: doi: 10.1002/ejhf.254.

Greene, S., Maggioni, A., Fonarow, G., Solomon, S., Böhm, M., Kandra, A. et al. (2015). Clinical profile and prognostic significance of natriuretic peptide trajectory following hospitalization for worsening chronic heart failure: findings from the ASTRONAUT trial. Eur J Heart Fail, 17(1), 98–108. doi: 10.1002/ejhf.201.

Schroten, N., Damman, K., Valente, M., Smilde, T., van Veldhuisen, D., Navis, G. et al. (2016). Long-term changes in renal function and perfusion in heart failure patients with reduced ejection fraction. Clin Res Cardiol, 105(1), 10–16. doi: 10.1007/s00392-015-0881-9.

Villacorta, H., Martins Santos, R., Baco Marroig, M., Guedes Pereira, G., Xavier, A., & Kanaan, S. (2015). Prognostic value of plasma neutrophil gelatinase-associated lipocalin in patients with heart failure. Revista Portuguesa De Cardiologia, 34(7–8), 473–478. doi: 10.1016/j.repc.2015.02.003.

Aleong, R., Mulvahill, M., Halder, I., Carlson, N., Singh, M., Bloom, H. et al. (2015). Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function. J Am Heart Assoc, 4(8), e001566. doi: 10.1161/JAHA.114.001566.

How to Cite

1.
Lashkul DA. Predictors of adverse events in patients with ischemic chronic heart failure with reduced ejection fraction and renal dysfunction. Zaporozhye Medical Journal [Internet]. 2016Sep.6 [cited 2024May20];18(3). Available from: http://zmj.zsmu.edu.ua/article/view/76914

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Section

Original research