IMR Press / RCM / Volume 20 / Issue 4 / DOI: 10.31083/j.rcm.2019.04.576
Open Access Original Research
Renal implications of pulmonary arterial capacitance in acute heart failure with preserved ejection fraction
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1 Department of Internal Medicine, Albert Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141, USA
2 Sidney Kimmel College of Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19107, USA
3 The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141, USA
Rev. Cardiovasc. Med. 2019 , 20(4), 267–272; https://doi.org/10.31083/j.rcm.2019.04.576
Submitted: 14 October 2019 | Accepted: 25 December 2019 | Published: 30 December 2019
Abstract

Worsening renal function in patients with heart failure with preserved ejection fraction is associated with poor outcomes. Pulmonary arterial capacitance is a novel right heart catheterization derived hemodynamic metric representing pulmonary arterial tree distensibility and right ventricle afterload. Given the strong association between heart failure, pulmonary hypertension, and kidney function, the goal of this study is to investigate the correlation between Pulmonary arterial capacitance and long-term renal function in patients with heart failure with preserved ejection fraction. In this retrospective single center study, data from 951 patients with the diagnosis of heart failure, who underwent right heart catheterization were analyzed. Eight hundred and one patients with reduced ejection fraction, end-stage kidney disease on hemodialysis, acute myocardial infarction, and severe structural valvular disorders, were excluded. Pulmonary arterial capacitance was calculated as the stroke volume divided by pulmonary artery pulse pressure (mL/mmHg). Hemodynamic and clinical variables including baseline renal function were obtained at the time of the right heart catheterization, and renal function was also obtained at 3-5 years after right heart catheterization. The final cohort consisted of 150 subjects with a mean age 68 ( ± 14.2) years, 93 (62%) were female. The mean value for Pulmonary arterial capacitance was 2.82 ( ± 2.22) mL/mm Hg and the mean Glomerular Filtration Rate was 60.32 mL/min/l.73 m2 ( ± 28.36). After multivariate linear regression analysis (including baseline Estimated Glomerular Filtration Rate as one of the variates), only age and Pulmonary arterial capacitance greater than 2.22 mL/mm Hg were predictors of long term Glomerular Filtration Rate. Pulmonary arterial capacitance as a novel right heart catheterization index could be a predictor of long-term renal function in patients with heart failure with preserved ejection fraction.

Keywords
Right-heart catheterization
pulmonary arterial capacitance
renal function
heart failure
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