Background and Objectives: The relationship between ejection fraction (EF), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and renal function is unknown as stratifed by heart failure (HF) type. We investigated their relation and the prognostic value of renal function in heart failure with preserved ejection fraction (HFpEF) vs. reduced ejection fraction (HFrEF). Materials and Methods: NT-proBNP, glomerular fltration rate (GFR), and EF were obtained in 1,932 acute heart failure (AHF) patients. HFrEF was defned as EF<50%, and renal dysfunction as GFR<60 mL/min/1.73 m2 (mild renal dysfunction: 30=GFR<60 mL/min/1.73 m2; severe renal dysfunction: GFR<30 mL/min/1.73 m2). The primary outcome was 12-month all-cause death. Results: There was an inverse correlation between GFR and log NT-proBNP level (r=-0.298, p<0.001), and between EF and log NT-proBNP (r=-0.238, p<0.001), but no correlation between EF and GFR (r=0.017, p=0.458). Interestingly, the prevalence of renal dysfunction did not differ between HFpEF and HFrEF (49% vs. 52%, p=0.210). Patients with renal dysfunction had higher 12-month mortality in both HFpEF (7.9% vs. 15.2%, log-rank p=0.008) and HFrEF (8.6% vs. 16.8%, log-rank p<0.001). Multivariate analysis showed severe renal dysfunction was an independent predictor of 12-month mortality (hazard ratio [HR], 2.08; 95% confdence interval [CI], 1.40'3.11). When stratifed according to EF: the prognostic value of severe renal dysfunction was attenuated in HFpEF patients (HR, 1.46; 95% CI, 0.66'3.21) contrary to HFrEF patients (HR, 2.43; 95% CI, 1.52'3.89). Conclusion: In AHF patients, the prevalence of renal dysfunction did not differ between HFpEF and HFrEF patients. However, the prognostic value of renal dysfunction was attenuated in HFpEF patients.
Bibliographical noteFunding Information:
This work was supported by the Korean Society of Heart Failure and the Korean Society of Cardiology. The KorHF Registry was conducted at 24 medical centers: The Catholic University of Korea, St. Mary’s Hospital; Chungnam National University Hospital; Chungbuk National University Hospital; Chonnam National University Hospital; Ewha Woman’s University Hospital; Eulji University Daejeon Hospital; Gacheon University Gil Hospital; Hallym University Sacred Heart Hospital; Hanyang University Guri Hospital; Jeju National University Hospital; Konkuk University Medical Centre; Keimyung University Hospital; Korea University Guro Hospital; Kyungpook National University Hospital; Sungkyunkwan University Samsung Medical Centre; Seoul National University Bundang Hospital; Seoul National University Hospital; Ulsan University Asan Medical Centre; Wonkwang University Hospital; Yonsei University Wonju Christian Hospital; Yeungnam University Hospital; Yonsei University Severance Hospital; Dongguk University Ilsan Hospital; Soonchunhyang University Cheonan Hospital; and Inje University Busan Paik Hospital.
© 2017. The Korean Society of Cardiology.
All Science Journal Classification (ASJC) codes
- Internal Medicine
- Cardiology and Cardiovascular Medicine