Clinical Research
Acute Myocardial Infarction
The Relationship Between Renal Function and Cardiac Structure, Function, and Prognosis After Myocardial Infarction: The VALIANT Echo Study

https://doi.org/10.1016/j.jacc.2007.06.018Get rights and content
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Objectives

The purpose of this study was to determine whether alterations in cardiac structure or function contribute to the increased risk associated with renal impairment after myocardial infarction (MI).

Background

Renal impairment is associated with adverse cardiovascular outcomes after MI.

Methods

Echocardiography was performed on 603 patients with left ventricular (LV) dysfunction, heart failure (HF), or both after MI. Patients were grouped according to their estimated glomerular filtration rate (eGFR), and measures of cardiac structure and function were related to baseline eGFR. The relationship between eGFR and cardiac structure and function and clinical outcomes of death or HF was assessed with multivariable Cox regression.

Results

Ejection fraction, infarct segment length, right ventricular function, and mitral deceleration time were not influenced by renal function. Patients with reduced eGFR had smaller LV and larger left atrial (LA) volumes and higher left ventricular mass index (LVMI) and LV mass/LV volume ratio. A greater proportion of the patients with reduced eGFR had LV hypertrophy. The relationship between eGFR and the outcome of death or HF was attenuated by including baseline differences in LVMI, and both LVMI and LA volume conferred additional prognostic information in a multivariable model.

Conclusions

Renal impairment was associated with smaller LV and larger LA volumes and increased LVMI. Systolic function was similar when compared with patients with normal renal function. Thus, reduced systolic function cannot account for worse outcomes in patients with renal impairment after MI. Indirect measures of diastolic function suggest that diastolic dysfunction might be an important mediator of increased risk in this population.

Abbreviations and Acronyms

EDV
end-diastolic volume
EF
ejection fraction
eGFR
estimated glomerular filtration rate
ESRD
end-stage renal disease
ESV
end-systolic volume
HF
heart failure
LAVI
left atrial volume index
LVH
left ventricular hypertrophy
LVMI
left ventricular mass index
MR
mitral regurgitation
RVFAC
right ventricular fractional area of change

Cited by (0)

The VALIANT study was supported by a grant from Novartis Pharmaceuticals, East Hanover, New Jersey. See accompanying online Cardiosource Slide Set.

1

Drs. Arnold, Ghali, McMurray, Pfeffer, and Solomon have received research funding from Novartis Pharmaceuticals.

2

Dr. Velazquez has served as a consultant to and received honoraria from Novartis Pharmaceuticals.