The Relationship Between Renal The Relationship Between Renal Function and Cardiac Structure, Function and Cardiac Structure, Function, and Prognosis Function, and Prognosis Following Myocardial Infarction: Following Myocardial Infarction: The VALIANT Echo Study The VALIANT Echo Study Anil Verma, MD, Nagesh S. Anavekar, MD, Alessandra Meris, MD, Jens Jakob Thune, MD, J. Malcolm O. Arnold, MD, Jalal K. Ghali, MD, Eric J. Velazquez, MD, John J.V. McMurray, MD, Marc A. Pfeffer, MD, PhD, Scott D. Solomon, MD J Am Coll Cardiol 2007;50:1238-1245
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The Relationship Between Renal Function and Cardiac Structure, Function, and Prognosis Following Myocardial Infarction: The VALIANT Echo Study Anil Verma,
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The Relationship Between Renal The Relationship Between Renal Function and Cardiac Structure, Function and Cardiac Structure,
Function, and Prognosis Following Function, and Prognosis Following Myocardial Infarction: Myocardial Infarction:
The VALIANT Echo Study The VALIANT Echo Study
Anil Verma, MD, Nagesh S. Anavekar, MD, Alessandra Meris, MD,Jens Jakob Thune, MD, J. Malcolm O. Arnold, MD,
Jalal K. Ghali, MD, Eric J. Velazquez, MD, John J.V. McMurray, MD, Marc A. Pfeffer, MD, PhD, Scott D. Solomon, MD
• Background: Renal impairment is associated with adverse cardiovascular outcomes post-MI
• Objectives: To determine whether alterations in cardiac structure or function contribute to the increased risk associated with renal impairment following myocardial infarction (MI)
• Echocardiography was performed on 603 patients with left ventricular (LV) dysfunction, heart failure (HF), or both following MI. Patients were grouped according to their estimated glomerular filtration rate (eGFR), and measures of cardiac structure and function were related to baseline eGFR.
• The relationship between eGFR, cardiac structure and function, and clinical outcomes of death or heart failure was assessed using multivariable Cox regression.
The adjustment model included predictors of mortality identified from the overall VALIANT study: age (in years), sex, primary percutaneous transluminal coronary angioplasty post-MI, atrial fibrillation complicating MI, history of diabetes, history of hypertension, prior MI, Killip class, and a history of chronic obstructive pulmonary disease. In addition to the above risk factors, adjustment was also made for the echocardiographic variable of interest, with each variable entering separately into the model and treatment assignment. The echocardiographic variables were: LV end systolic volume, LV ejection fraction, left atrial volume index, ratio of mitral regurgitation area to left atrial area, RV fractional area shortening, and LV mass index.
Renal impairment was associated with smaller LV and larger LA volumes and increased LVMI. Systolic function was similar when compared with patients with normal renal function. Thus, reduced systolic function cannot account for worse outcomes in patients with renal impairment post-MI. Indirect measures of diastolic function suggest that diastolic dysfunction may be an important mediator of increased risk in this population.