Russian Heart Failure Journal 2008year Atrial fibrillation in patients with CHF is associated with impaired renal function

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Atrial fibrillation in patients with CHF is associated with impaired renal function

Shutov A.M., Serov V.A., Kurzina E.V., Shevchenko S.V., Gerdt A.M., Serova D.V.



Urgency. Recent studies have shown that renal function is an important predictor in CHF. Atrial fibrillation (AF) is a type of arrhythmia commonly observed in practice, particularly in patients with CHF. However a possible effect of impaired renal function on development of AF is not studied. Aim. To specify the relationship between impaired renal function and AF in patients with CHF. Materials and methods. 340 patients (200 men and 140 women; mean age 58±13 years) were evaluated. CHF was induced by AH in 44 (13 %) patients; IHD – in 112 (33 %) patients; and combination of AH and IHD – in 184 (54 %) patients. 112 (33 %) patients had FC I CHF, 177 (52 %) patients had FC II CHF, 34 (10 %) patients had FC III CHF, and 17 (5 %) patients had FC IV CHF. Glomerular filtration rate (GFR) was calculated using the MDRD formula. 30 patients had paroxysmal/persistent AF and 27 patients had constant AF. Results. Mean GFR was 68.8 ± 20.9 mL/min/1.73 m2 (19.2–149.7 mL/min/1.73 m2); 114 (34 %) patients had GFR <60 mL/min/1.73 m2. LV EF was 56.9 ± 10.5 %. Systolic dysfunction was detected in 90 (26 %) patients. Patients with impaired renal function had a larger left ventricular (LV) diameter than patients with preserved renal function (GFR <60 mL/min/1.73 m2 – 42.2 ± 5.8 mm vs. GFR ≥60 mL/min/1.73 m2 – 40.1± 5.4 mm, respectively, p =0.001). GFR was lower in patients with AF than without AF (58.8 ± 14.2 mL/min/1.73 m2 vs. 69.1±18.8 mL/min/1.73 m2, respectively; p <0.001). Logistic regression analysis showed that chronic renal disease (CRD) (RR: 2.3; 95% confidence interval: 1.2–4.3) and CHF FC (RR: 1.8; 95% CI: 1.0–3.1) were independently associated with impaired renal function, which can be probably attributed to the effect of CRD factors on heart remodeling.
    1.    Grandea A. Atrial Fibrillation and Dialysis. A Convergence of Risk Factors. Rev Esp Cardiol. 2006; 59 (8):766–769.
    2.    Kocheril AG. Arrhythmia issues in patients with renal disease. Semin Nephrol. 2001;21 (1):57–65.
    3.    Genovesi S, Pogliani D, Faini A et al. Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients. Am J Kidney Dis. 2005;46 (5):897–902.
    4.    Tsang TS, Gersh BJ, Appleton CP et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol. 2002;40 (9):1636–1644.
    5.    Шутов А. М., Машина Т. В., Мардер Н. Я. и др. Хроническая сердечная недостаточность у больных с хронической болезнью почек. Нефрология и диализ. 2005;7 (2):140–144.
    6.    Hayashi SY, Rohani M, Lindholm B et al. Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant. 2006;21 (1):125–132.
    7.    Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54 (2):230–234.
    8.    Amann K, Ritz E. Cardiovascular abnormalities in ageing and in uraemia – only analogy or shared pathomechanisms? Nephrol Dial Transplant. 1998;13 (Suppl 7):6–11.
    9.    Atar I, Konaş D, Açikel S et al. Frequency of atrial fibrillation and factors related to its development in dialysis patients. Int J Cardiol. 2006;106 (1):47–51.
    10.    Шутов А. М., Мастыков В. Э., Едигарова О. М. и др. Влияние сеанса гемодиализа на трансмитральный кровоток. Нефрология 2003;7 (2):67–71.
    11.    Szabó Z, Kakuk G, Fülöp T et al. Effects of haemodialysis on maximum P wave duration and P wave dispersion. Nephrol Dial Transplant. 2002;17 (9):1634–1638.
    12.    The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987;316 (23):1429–1435.
    13.    Национальные Рекомендации ВНОК И ОССН по диагностике и лечению ХСН (второй пересмотр). Журнал Сердечная Недостаточность. 2007;8 (1):4–41.
    14.    National Kidney Foundation KD: Clinical practice guidelines for chronic kidney disease: Evaluation, classification and stratification. Am J Kidney Dis. 2002;39 (Suppl 1): S1‑S266.
    15.    Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285 (18):2370–2375.
    16.    Feinberg WM, Blackshear JL, Laupacis A et al. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995;155 (5):469–473.
    17.    Furberg CD, Psaty BM, Manolio TA et al. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol. 1994;74 (3):236–241.
    18.    The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992;327 (10):685–691.
    19.    Шутов А. М., Тармонова Л. Ю. Нарушение функции почек и анемия у больных пожилого возраста с диастолической сердечной недостаточностью. Тер. архив. 2007;79 (12):47–51.
    20.    van Berlo JH, de Voogt WG, van der Kooi AJ et al. Meta-analysis of clinical characteristics of 299 carriers of LMNA gene mutations: do lamin A / C mutations portend a high risk of sudden death? J Mol Med. 2005;83 (1):79–83.
    21.    Pokharel S, van Geel PP, Sharma UC et al. Increased myocardial collagen content in transgenic rats overexpressing cardiac angiotensin-converting enzyme is related to enhanced breakdown of N-acetyl-Ser-Asp-Lys-Pro and increased phosphorylation of Smad2 / 3. Circulation. 2004;110 (19):3129–3135.
    22.    Maixent JM, Paganelli F, Scaglione J et al. Antibodies against myosin in sera of patients with idiopathic paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 1998;9 (6):612–617.
    23.    Lee YA, Liang CS, Lee MA, Lindpaintner K. Local stress, not systemic factors, regulate gene expression of the cardiac renin-angiotensin system in vivo: a comprehensive study of all its components in the dog. Proc Natl Acad Sci U S A. 1996;93 (20):11035–11040.
    24.    Goette A, Staack T, Rocken C et al. Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation. J Am Coll Cardiol. 2000;35 (6):1669–1677.
    25.    Aviles RJ, Martin DO, Apperson-Hansen C et al. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003;108 (24):3006–3010.
    26.    Chung MK, Martin DO, Sprecher D et al. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation. 2001;104 (24):2886–2891.
    27.    Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis. 2000;35 (Suppl 1): S117‑S131.
    28.    Gerdes AM. Cardiac myocyte remodeling in hypertrophy and progression to failure. J Card Fail. 2002;8 (Suppl 6): S264‑S268.
    29.    Katz AM, Zile MR. New Molecular Mechanism in Diastolic Heart Failure. Circulation. 2006;113 (16);1922–1925.
    30.    Acil T, Wichter T, Stypmann J et al. Prognostic value of tissue Doppler imaging in patients with chronic congestive heart failure. Int J Cardiol. 2005;103 (2):175–181.
    31.    Bruch C, Klem I, Breithardt G et al. Diagnostic usefulness and prognostic implications of the mitral E / E’ ratio in patients with heart failure and severe secondary mitral regurgitation. Am J Cardiol. 2007;100 (5):860–865.
    32.    Bruch C, Rothenburger M, Gotzmann M. Chronic kidney disease in patients with chronic heart failure-impact on intracardiac conduction, diastolic function and prognosis. Int J Cardiol. 2007;118 (3):375–380.
    33.    Bruch C, Reinecke H, Rothenburger M et al. Transmitral flow patterns and the presence of chronic kidney disease provide independent and incremental prognostic information in patients with heart failure and systolic dysfunction. J Am Soc Echocardiogr. 2007;20 (8):989–997.
    34.    Hillege HL, Girbes AR, De Cam PJ et al. Renal function, neurohormonal activation and survival in patients with chronic heart failure. Circulation. 2000;102 (2):203–210.
    35.    Ix JH, Shlipak MG, Katz R et al. Kidney function and aortic valve and mitral annular calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis. 2007;50 (3):412–420.
    36.    Горохова С. Г. Оценка влияния дегенеративных изменений клапанов сердца на структуру и функцию левого желудочка у больных сердечной недостаточностью пожилого возраста. Клин геронтол. 2000;11–12:18–25.

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