Structural and functional changes of the heart in patients with chronic ischemic heart failure, associated with renal dysfunction

Kidney disease is a frequent complication of congestive heart failure (CHF) and may contribute to the progression of ventricular dysfunction. Regardless of the degree of heart failure, chronic kidney disease (CKD) increases the risk of death and cardiac decompensation. Left ventricular hypertrophy (LVH) is a known parameter of cardiac remodelling and has a higher prevalence and incidence among people with impaired kidney function. LVH is an early subclinical marker of cardiovascular disease and heart failure risk, and is probably an intermediary step in the pathway leading from kidney dysfunction to heart failure and its complications. The effects of CKD on other left ventricular and myocardial parameters, however, have been less characterized. The aim of the study was to examine the structural and functional changes, geometric remodeling of the heart in patients with ischemic chronic heart failure, being hospitalized, according to the presence of renal dysfunction. Materials and methods. The study involved 333 patients with ischemic CHF (277 men and 56 women, mean age 59,3±9,4 years). The functional class of heart failure was assessed on the recommendations of the New York Heart Association (NYHA). The etiology of heart failure in 288 (86.5%) patients had a combination of coronary artery disease and essential hypertension, in 45 (13.5%) – only CAD. 1 FC of heart failure was diagnosed in 9 (2.7%) patients, 2 FC - in 106 (31.8%), 3 FC - in 199 (59.8%) and 4 FC - 19 (5.7%) patients. Diabetes was in 61 (18.3%), myocardial infarction history was in 240 (72.1%) patients. Depending on the glomerular filtration rate, patients were divided into 3 groups: 72 with normal GFR (>90 ml/min/1.73m2), 218 with a slight decrease in GFR (60-90 ml/min/1.73m2) and 43 with moderate reduced GFR (<60 ml/min/1.73m2). Echocardiography was performed using the General Electric VIVID 3 system (General Electric Healthcare, USA) with the 2.5–3.5 MHz transducer and Doppler technique. Descriptive statistics are presented as mean±standard deviation for continuous variables and as percentages for categorical variables. Depending on the distribution of the analyzed parameters used unpaired Student's t-test or U-Mann-Whitney test. Comparisons among all groups for baseline clinical variables were performed with the Pearson χ2 or Fisher exact test for categorical variables. Differences considered reliable for values of p