所属 医学部 医学科（東京女子医科大学病院） 職種 助教
|発表タイトル||Left Ventricular Contraction Affects the Impact of Worsening Renal Function on Long-term Mortality of Patients With Acute Heart Failure|
|会議名||American Heart Association (AHA) Scientific Sessions 2017|
|主催者||American Heart Association|
|発表者・共同発表者||JUJO Kentaro, ◎KAMETANI Motoko, MINAMI Yuichiro, TANIGAITO Yusuke, KIKUCHI Yasuhiro, ISHIDA Issei, MIZOBUCHI Keiko, HARUKI Shintaro, KADOWAKI Hiromu, AKASHI Madoka, SAKAMOTO Tomohiro, HAGIWARA Nobuhisa|
|学会抄録||Circulation 136(suppl 1),A19095 2017|
|概要||Introduction: Acute heart failure (HF) patients with preserved (HFpEF) and reduced left ventricular ejection fraction (HFrEF) have different comorbidities. However, the relationships between kinetics of renal function during hospitalization in these two subpopulations of HF and clinical prognosis is not fully discussed. We aimed to compare the impact of worsening renal function (WRF) on clinical prognosis between acutely decompensated HFpEF and HFrEF patients.
Methods: This study initially included 403 consecutive patients without regular hemodialysis who were urgently hospitalized due to acute HF between 2013 and 2016. The enrolled patients were divided into 4 groups depending on EF with cut-off value of 40%, and incidence of WRF within 4 days after the admission. WRF was defined as an increase >0.3 mg/dL in serum creatinine from baseline. The primary endpoint of this study was all-cause mortality.
Results: Among the study population, WRF was developed during 4 days in 21 patients in 190 HFrEF, and 31 patients in 213 HFpEF (11.1% vs. 14.6%, p=0.30). In-hospital mortality was not different between HFrEF and HFpEF (12.1% vs. 8.5%, p=0.25); while, WRF significantly increased in-hospital mortality in both group (HFrEF: 28.6% vs. 10.1%, p=0.026; HFpEF: 19.4% vs. 6.6%, p=0.030). During 409 days of median observational period, all-cause death occurred in 95 patients (23.6%). Kaplan-Meier analysis showed that HFrEF and HFpEF had a similar all-cause mortality when WRF did not occur; however, HFrEF had a significantly higher mortality than HFpEF in patients with WRF (Log-rank test: p=0.045, Figure). It also suggested that WRF worsened clinical prognosis in HFrEF, but not in HFpEF of this study population (p<0.001, p=0.08, respectively).
Conclusions: WRF in an early phase of hospitalization worsened clinical prognosis predominantly in acute HF patients with reduced EF.