Dataset Information

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012-2015).

ABSTRACT:

Background

Heart failure (HF) is a leading cause of hospitalization and mortality for older chronic kidney disease (CKD) patients. However, the epidemiological data is scarce. We aimed to determine the prevalence of left ventricular (LV) dysfunction and HF, and to explore the risk factors for HF among those patients.

Methods

This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015. A total of 5, 808 participants aged ≥ 65 years were included in the analysis. Self-reported history of HF and any other cardiovascular diseases was acquired. 2-D and Doppler echocardiography were used to assess LV dysfunction. CKD was defined as either estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m² or urinary albumin to creatinine ratio (ACR) ≥ 30 mg/g.

Results

Among CKD patients aged ≥ 65 years, the weighted prevalence of HF, heart failure with preserved ejection fraction (HFpEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF) was 4.8%, 2.5%, 0.8%, and 1.7%, respectively. The weighted prevalence of HF was 5.0% in patients with eGFR < 60 mL/min per 1.73 m², and was 5.9% in patients with ACR ≥ 30 mg/g. The prevalence of LV systolic dysfunction was 3.1%, and while it was 8.9% for moderate/severe diastolic dysfunction. Multivariate analysis showed that smoking was significantly associated with the risk of HF. Furthermore, age, smoking, and residents in rural areas were significantly associated with a risk of LV diastolic dysfunction.

Conclusions

The prevalence of HF and LV dysfunction was high in older patients with CKD, suggesting that particular strategies will be required.

SUBMITTER: Wang X

PROVIDER: S-EPMC7657946 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Publications

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012-2015).

Wang Xin X Hao Guang G Chen Lu L Zhang Lin-Feng LF Chen Zuo Z Kang Yu-Ting YT Yang Ying Y Zheng Cong-Yi CY Zhou Hao-Qi HQ Wang Zeng-Wu ZW Gao Run-Lin RL For The China Hypertension Survey Investigators

Journal of geriatric cardiology : JGC 20201001 10

<h4>Background</h4>Heart failure (HF) is a leading cause of hospitalization and mortality for older chronic kidney disease (CKD) patients. However, the epidemiological data is scarce. We aimed to determine the prevalence of left ventricular (LV) dysfunction and HF, and to explore the risk factors for HF among those patients.<h4>Methods</h4>This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015. A total of 5, 808 participants aged ≥ 65 ...[more]

PMID: 33224178

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Project description:This study aimed to investigate the functional correlate, clinical relevance, and prognostic implications of novel left ventricular (LV) deformations in patients with atrial fibrillation (AF). LV deformational indices, including peak global longitudinal strain (GLS), systolic strain rates (SRs), and early diastolic strain rates (SRe) were measured in a large-scale AF population. We related such measures to key clinical heart failure (HF) markers, conventional echocardiographic ventricular parameters, and clinical outcomes. Among 1483 subjects with newly diagnosed AF (mean age, 71.6 ± 12.4 years; 55.5% male), worsened GLS (mean, - 12.6 ± 3.9%) and strain rates (SRs and SRe: mean, - 0.86 ± 0.27 and 1.25 ± 0.41 1/s, respectively) by our three-beat measures were independently correlated with higher C-reactive protein, N-terminal pro-B-type natriuretic peptide, higher E/e', more impaired LV ejection fraction (LVEF < 50%), lower estimated glomerular filtration rate, permanent AF, and prevalent HF (all P < 0.05). LV deformations by three-beat analysis well correlated with the respective results of traditional methods. Abnormal GLS (>- 14.7%) was common in our cohort (67.8%) despite an averaged preserved LVEF (58.4 ± 14.2%), with worse GLS and SRe being associated with higher composite HF re-admissions/death during the 2.9 year follow-up (inter-quartile range, 1.6-4.1 years) in multivariate models incorporating key LV indices (LVEF, LV mass index, and E/e') (all P < 0.001). Sensitivity analysis by excluding those with regional wall motion abnormality showed broadly similar findings. An improved risk reclassification was observed when GLS and SRe were separately added to the LVEF. Comparison of the AF cohort with a fully matched independent non-AF cohort at the same baseline LVEF level showed a substantially lower GLS [- 13.2 ± 3.8% (AF) vs. 18.1 ± 3.2% (non-AF)] and higher clinical events rate (hazard ratio, 1.41 [95% confidence interval, 1.14-1.75]; log-rank P = 0.002) in the AF cohort. Impaired LV function defined by myocardial deformation was common in patients with AF and provides independent prognostic values over conventional measures with improved risk prediction. Our data highlight the need for implementing cardiac deformations in daily practice for patients with AF.

Dataset Information

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012-2015).

Background

Methods

Results

Conclusions

Publications

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012-2015).

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