Kidney Week

Abstract: FR-OR53

Subclinical Cardiopulmonary Changes of Heart Failure with Preserved Ejection Fraction (HFpEF) in CKD

Session Information

• Hypertension, CVD, and the Kidneys: Clinical Studies
  October 25, 2024 | Location: Room 5, Convention Center
  Abstract Time: 05:40 PM - 05:50 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Stevenson, Alexis, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Alexis Stevenson

• Zimkute, Marija, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Marija Zimkute

• Cai, Xuan, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Xuan Cai

• Ahmed, Moeed, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Moeed Ahmed, MBBS

• Schiller, Patrick T., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Patrick T. Schiller, MD

• Thach, Lonnie, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Lonnie Thach, MD

• Kula, Alexander J., Ann and Robert H Lurie Children's Hospital of Chicago Pritzker Research Library, Chicago, Illinois, United States

Alexander J. Kula, MD, MS

• Shah, Sanjiv, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Sanjiv Shah, MD

• Patel, Ravi B., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Ravi B. Patel, MD, MSc

• Mehta, Rupal, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Rupal Mehta, MD, MS, FASN

Background

Phenotypic data which include dynamic measurements of cardiac mechanics and cardiopulmonary function that characterize HFpEF in patients with CKD are limited.

Methods

We performed pre-, peak- and post-exercise speckle tracking echocardiography (2D-STE) and cardiopulmonary exercise testing (CPET) in individuals with and without CKD, and without diabetes or HF as part of a primary recruitment, detailed physiologic, patient-oriented study (Figure 1), We used regression models adjusted for age, sex, race, systolic blood pressure and body mass index to test the independent association between estimated glomerular filtration rate (eGFR) and 2D-STE and CPET indices.

Results

Table 1 displays baseline characteristics of 68 individuals according to CKD status. Only 3 patients with CKD met American Heart Association 2D-echocardiographic criteria for diastolic dysfunction. However, 13/54 and 26/54 with CKD and 1/14 and 2/14 without CKD had reduced left atrial reservoir strain (LARS) and left ventricular longitudinal strain (LVLS), markers of subclinical HFpEF, on resting 2D-STE. At 50 Watts exercise, 20/53 with CKD and 5/13 without CKD had lack of LARS or LVLS augmentation (Figure 2, LVLS Strain). During exercise, 32/53 with CKD and 4/13 without CKD had depressed peak V02, a manifestation of HFpEF. eGFR was independently associated with peak V02 (β-estimate 0.11 per 1 unit increase in eGFR, p value 0.0006, Figure 3).

Conclusion

Exercise 2D-STE and CPET can elucidate relevant physiologic changes suggestive of HFpEF that may be missed on resting 2D-echocardiography. Dynamic exercise testing in patients with CKD can lead to early and more accurate HFpEF diagnoses in a population at high risk for developing HFpEF.

Funding

• Other NIH Support