Correlation Between Cardiac Structure And Function And Renal Function In Heart Failure With Preserved Ejection Fraction Patients

Objective:To explore the effects of right ventricular load and pulmonary artery pressure on the formation of renal dysfunction in heart failure with preserved ejection fraction(HFpEF)patients by analyzing the characteristics of cardiac structure and function in HFpEF patients.Methods:According to the inclusion and exclusion criteria,178 patients with HFpEF were selected from the Department of Cardiology,Shanxi Bethune Hospital,from January2021 to December 2022.According to the presence or absence of renal dysfunction,they were divided into HFpEF with renal dysfunction group(e GFR<60ml/min/1.73m~2)and HFpEF renal function normal group(e GFR≥60ml/min/1.73m~2)as control group.The estimated glomerular filtration rate(e GFR)was calculated by The Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI).1.The general clinical data,laboratory data and echocardiographic data of the two groups were collected and compared between the two groups.2.Taking renal dysfunction in HFpEF patients as dependent variable,echocardiography and other related indexes with statistical difference between renal dysfunction group and normal renal function group as independent variables,Logistic regression analysis of risk factors of renal dysfunction in HFpEF patients was carried out.3.The receiver operating characteristic curve(ROC)was drawn to evaluate the efficacy of left atrial diameter(LAD),right atrium diameter(RAD),right ventricular anterior wall(RVAW),right ventricular diameter(RVD),pulmonary artery systolic pressure(PASP)and right atrial pressure(RAP)in predicting renal dysfunction in patients with HFpEF.4.From 78 patients with HFpEF complicated with renal dysfunction,52 patients with improved cardiac function and renal function were selected,and the correlation between the improvement of cardiac function and renal function during hospitalization was analyzed.Results:1.The comparison of general clinical data between the two groups showed that compared with the group with normal renal function,the proportion of NYHA cardiac function grade IV,the incidence of atrial fibrillation,the incidence of chronic obstructive pulmonary disease,and the incidence of anemia in the renal dysfunction group were higher(P<0.05);The comparison of laboratory examination data and echocardiographic data between the two groups showed that compared with the group with normal renal function,the serum creatinine,urea nitrogen,e GFR,LAD,RAD,RVAW,RVD,PASP,RAP,Growth stimulation expressed gene 2(ST2),Brain natriuretic peptide(BNP)in the renal dysfunction group were significantly higher than those in the group with normal renal function(P<0.05),while hemoglobin and erythrocyte specific volume were significantly lower(P<0.05).2.Logistic regression analysis showed that LAD,RAD,RVAW,RVD,PASP,RAP,atrial fibrillation,and chronic obstructive pulmonary disease were all risk factors for renal dysfunction in HFpEF patients.3.The ROC curve shows that LAD,RAD,RVAW,RVD,PASP,and RAP have certain predictive value for renal dysfunction in HFpEF patients.4.Correlation analysis showed that there was a significant positive correlation between the improvement of cardiac function and the improvement of renal function in patients with HFpEF and renal dysfunction during hospitalization;Multiple linear regression analysis suggested that△hemoglobin(discharge hemoglobin-admission hemoglobin)and△red blood cell specific volume(discharge red blood cell specific volume-admission red blood cell specific volume)reflecting blood concentration during hospitalization could explain the 52.2%change in△e GFR renal function improvement△e GFR(discharge e GFR-admission e GFR).Conclusion:HFpEF patients with renal dysfunction have worse cardiac function,larger l left atrium diameter,heavier fluid load in the right heart(right atrium diameter,right ventricular anterior wall,right ventricular diameter,right atrial pressure increases significantly),higher pulmonary artery systolic pressure,and higher combined rates of atrial fibrillation,chronic obstructive pulmonary disease,and anemia.The above cardiac ultrasound indicators reflecting right heart load and pulmonary artery pressure have certain predictive value for renal dysfunction in HFpEF patients.Treatment to correct heart failure such as decongestation during hospitalization may be beneficial for the improvement of renal dysfunction.