Relation of Cardiorenal Syndrome to Mitral and Tricuspid Regurgitation in Acute Decompensated Heart Failure

https://doi.org/10.1016/j.amjcard.2021.12.024Get rights and content

This study aimed to investigate the role of secondary mitral regurgitation (MR) and tricuspid regurgitation (TR) in the pathogenesis of cardiorenal syndrome (CRS). Worsening renal function in patients with acute decompensated heart failure receiving diuretic therapy is defined as CRS and is related to central venous congestion. The role of secondary MR and TR is not well studied. We retrospectively reviewed the electronic medical records of 80 consecutive patients hospitalized with acute decompensated heart failure. Patients were divided into 2 groups: group 1 (CRS) if creatinine increased >0.3 mg/dl from baseline and group 2 (no CRS) if creatinine remained stable or improved with diuretic therapy. Admission creatinine was higher in group 1 compared with group 2 (1.5 vs 1.2 mg/dl, p = 0.033). The magnitude of MR and TR were higher by both visual assessment (moderate to severe [3+] or severe [4+] MR in 68% of patients in group 1 vs 3% in group 2, p <0.0001; 3+ or 4+ TR in 48% of patients in group 1 vs 10% in group 2, p = 0.0004) and by vena contracta (MR 0.6 ± 0.2 cm in group 1 vs 0.4 ± 0.1 cm in group 2, p <0.0001; TR 0.5 ± 0.2 cm in group 1 vs 0.4 ± 0.2 cm in group 2, p = 0.0013). By using receiver operating characteristic curves, MR and TR were the most sensitive parameters in predicting CRS. In conclusion, renal function on admission and moderate to severe or severe MR and TR are highly predictive of the risk of developing CRS.

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Methods

The study is a retrospective review of electronic medical records of 80 consecutive patients admitted with ADHF to the cardiac care unit or cardiology wards of the University of Alabama at Birmingham Hospital between November 2018 and December 2019 and treated by the clinicians with the intention to treat. Patients were included if they were >18 years old and carried a diagnosis of HFrEF with severe left ventricular (LV) dysfunction (mean LV ejection fraction [EF] 20.7 ± 8%) in ADHF. The

Results

The final cohort included 70 patients who were divided into 2 groups according to their renal function response to diuretic therapy: group 1 (n = 31) comprised patients with worsening renal function (CRS) and group 2 (n = 39) comprised patients without worsening renal function (no CRS). There was no difference between the 2 groups with respect to demographics and medications used for heart failure. However, group 1 exhibited higher serum creatinine levels on admission compared with group 2

Discussion

Our study indicates that in patients with HFrEF hospitalized with ADHF, baseline renal dysfunction and moderate to severe (3+) or severe (4+) functional MR and/or TR are strong predictors of the development of CRS while receiving diuretic therapy.

It is well known that severe LV dysfunction is associated with functional MR because of disruption of mitral apparatus and malcoaptation of mitral leaflets. MR begets MR, which in turn leads to elevated left atrial and pulmonary capillary pressure. The

Disclosures

The authors have no conflicts of interest to declare.

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  • The research reported in this manuscript was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (Bethesda, Maryland) under award number UL1TR003096.

    The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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