A543JACC April 1, 2014

Volume 63, Issue 12

Congenital Heart Disease

PrOgnOstic imPlicatiOn Of left Ventricular functiOn amOng Patients with acute kiDney injury anD acute DecOmPensateD heart failure

Poster ContributionsHall CSunday, March 30, 2014, 9:45 a.m.-10:30 a.m.

Session Title: Heart Failure and Cardiomyopathies: Challenge of Acute Decompensated Heart FailureAbstract Category: 12. Heart Failure and Cardiomyopathies: ClinicalPresentation Number: 1186-185

Authors: Sabry Omar, Elsayed Abo-Salem, Sian Yik Lim, Jason Wischmeyer, Sharma Prabhakar, Texas Tech University Health Science Center, Lubbock, TX, USA

background:Acute kidney injury (AKI) is a common complication among patients with acute heart failure (AHF) (30%) and is associated with increased in-hospital mortality and readmission. Limited data are available about the impact of left ventricular systolic function on the prognosis of these patients.

methods: Medical records of patients who were admitted with AHF and AKI between 2008 and 2010 were reviewed. The patients were divided into two groups: AHF with reduced ejection fraction ( HFrEF; left ventricular ejection fraction (LVEF) ≤ 45%), and AHF with preserved ejection fraction ( HFpEF; LVEF > 45%). AKI was defined as a rise of serum creatinine > 0.3 mg/dL above the baseline.

results: We studied 244 patients with AHF and AKI (121 male and 123 female) with a mean age of 64.12 ± 16.4. The in-hospital mortality, 30-days readmission and requirement for dialysis were significantly higher in the HFrEF compared to HFpEF (Table 1). In the multivariate logistic regression model, the only independent predictors of mortality were the use of beta blockers (Odds ratio: 0.27, 95% confidence interval(CI): 0.88 to 0.84, P = 0.02) and angiotensin converting enzyme (ACE) inhibitors (Odds ratio: 0.272, 95% CI: 0.07 to 0.96, P = 0.04).

conclusions: Among cases with AKI and AHF, the mortality, readmission rates and requirement of dialysis were significantly higher in those with HFrEF than HFpEF. The use of beta blockers and ACE inhibitors were independent predictors of reduced mortality in both groups.

HfrEF HfpEF P valueTotal number 135 109Baseline characteristics Age 60.94 ±17.7 68.02 ±13.7 0.0001LV ejection fraction % (median) 25 59 0.0001Estimated GFR mg/dL (mean) 57.51 ±21.7 56.18 ±24.8 0.658DM (%) 65.92 77.98 0.054HTN (%) 57.78 84.40 0.001B-blockers (%) 55.6 63 0.027ACEI (%) 48 64 0.046OutcomeIn-hospital mortality (%) 11.1 4 0.023Days in hospital (median) 9.4 7.8 0.016Readmission within 3 months (%) 66.4 44.1 0.0001Dialysis requirement (%) 8.9 2.8 0.04

Table 1