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Takei M, Kohsaka S, Shiraishi Y, Goda A, Izumi Y, Yagawa M, Mizuno A, Sawano M, Inohara T, Kohno T, Fukuda K, Yoshikawa T. Effect of estimated plasma volume reduction on renal function for acute heart failure differs between patients with preserved and reduced ejection fraction. Circ Heart Fail 2015; 8:527-32. [PMID: 25737498 DOI: 10.1161/circheartfailure.114.001734] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 02/27/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND The prognostic relevance of plasma volume reduction (PVR) in acute heart failure patients remains unclear because of the confounding hemodynamic effect of left ventricular ejection fraction impairment on kidney function. METHODS AND RESULTS Subjects enrolled in the West Tokyo Heart Failure Registry were examined. The PV at admission and discharge was estimated from the subjects' body weight and its deviation from the ideal body weight. Patients in the top tertile of estimated PVR were classified as PVR+. Of the 381 patients with acute heart failure, 181 (47.5%) had heart failure with preserved ejection fraction (HFpEF). Estimated PVR was associated with worsening renal function in the HFpEF (odds ratio, 3.28; 95% confidence interval, 1.55-6.96; P=0.002) but not in the heart failure with reduced ejection fraction cohort (odds ratio, 1.22; 95% confidence interval, 0.61-2.42; P=0.57). This association in the HFpEF cohort remained significant after adjusting for a history of hypertension and diabetes mellitus and the estimated glomerular filtration rate (odds ratio, 3.34; 95% confidence interval, 1.52-7.33; P=0.003). The use of intravenous diuretics was a significant predictor of PVR in the HFpEF and heart failure with reduced ejection fraction groups. CONCLUSIONS The effect of estimated PVR differs by HF type, and the estimated PVR during hospitalization is a predictor of worsening renal function in patients with HFpEF but not in heart failure with reduced ejection fraction. CLINICAL TRIAL REGISTRATION URL: http://www.umin.ac.jp/ctr/index-j.html. Unique identifier: UMIN000001549.
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Affiliation(s)
- Makoto Takei
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Shun Kohsaka
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
| | - Yasuyuki Shiraishi
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Ayumi Goda
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Yuki Izumi
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Mayuko Yagawa
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Atsushi Mizuno
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Mitsuaki Sawano
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Taku Inohara
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Takashi Kohno
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Keiichi Fukuda
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
| | - Tsutomu Yoshikawa
- From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.)
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