A Possible Mechanisms of Cardio-Renal Syndrome in Elderly Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction

Introduction: Congestive kidney failure provoked by increased central venous pressure is clinically important in patients with heart failure and preserved ejection fraction (HFpEF), however, the underlying mechanisms of increase in central venous pressure remains unclear. The present study aimed to examine the relationship between right ventricular distensibility and estimated glomerular filtration rate (eGFR) in patients with HFpEF. Material and Methods: Retrospective and cross-sectional study was performed based on echocardiographic database of our hospital between 2012 and 2014, and 45 of 138 elderly patients with HFpEF had reduced eGFR (<60 mL/min). We identified 45 patients with preserved eGFR matched to the reduced eGFR population for age and sex. Using signal processing techniques, the prominent Y descent of jugular pulse waveform was detected as a hemodynamic sign of less-distensible right ventricle (RV). Results: Patients with reduced eGFR had larger left atrial diameters and higher right ventricular systolic pressure as compared to those with preserved eGFR (42 ± 8 mm vs 39 ± 7 mm, P = .04; 38 ± 10 mmHg vs 33 ± 8 mmHg, P = .02, respectively). Less-distensible RV was more prevalent in patients with reduced eGFR than those with preserved eGFR (47% vs 16%, P = .003). Multivariate conditional logistic regression analysis revealed that less-distensible RV was an independent risk factor for reduced eGFR (odds ratio = 5.9, P = .02). Conclusion: Less-distensible RV is a possible mechanism of cardio-renal syndrome in elderly patients with HFpEF.