d10a8f9a3d5fa59cc675951197aac901 diagnostics-14-01576.pdf b75e99e4621a621042500dcba6917927ea1bf28a diagnostics-14-01576.pdf 55d787397c0a7a69fa898363d61bd437016a9297c0ea279ce869d4a239bd1680 diagnostics-14-01576.pdf Title: Right Ventricular and Right Atrial Strain Are Associated with Kidney Dysfunction in Acute Heart Failure Subject: Background: In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. This study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute HF. Methods and Results: A total of 377 patients hospitalized for acute HF were prospectively evaluated. Estimated glomerular filtration rate (eGFR) on admission was measured using the 2021 Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Advanced echocardiographic assessment was performed on admission. Patients with eGFR < 45 mL/min/1.73 m2 were more likely to have chronic heart failure, chronic atrial fibrillation, and type 2 diabetes mellitus compared to patients with eGFR 45 mL/min/1.73 m2. Patients with lower eGFR had lower cardiac output, higher mean E/e’ ratio, larger right ventricular (RV) size, worse RV free wall longitudinal strain, more impaired right atrial (RA) reservoir strain, and more frequent severe tricuspid regurgitation. RV free wall longitudinal strain and RA reservoir strain were the only independent echocardiographic associates of low eGFR, whereas cardiac output was not. Conclusions: Impaired RV and RA longitudinal strain were independently associated with eGFR < 45 mL/min/1.73 m2 in acute HF, while reduced cardiac output was not. This suggests that RV and RA dysfunction underlying venous congestion and increased renal afterload are more important pathophysiological determinants of renal impairment in acute HF than reduced cardiac output. Keywords: acute heart failure; renal impairment; increased renal afterload; right ventricular strain; right atrial strain Author: Vasileios Anastasiou, Emmanouela Peteinidou, Christos Tountas, Stylianos Daios, Dimitrios V. Moysidis, Emmanouil Fardoulis, Christos Gogos, Marieta Theodorakopoulou, Fotini Iatridi, Pantelis Sarafidis, George Giannakoulas, Theodoros Karamitsos, Victoria Delgado, Antonios Ziakas and Vasileios Kamperidis Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Sun Jul 21 11:04:21 2024 CEST ModDate: Sun Jul 21 11:07:52 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1399347 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- EVTCHK+URWPalladioL-Bold Type 1 Custom yes yes yes 10 0 UEWZNB+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 RYIADX+URWPalladioL-Ital Type 1 Custom yes yes yes 21 0 JGMOZW+CMSY10 Type 1 Builtin yes yes yes 26 0 BXZUUH+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 42 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes yes 65 0 MFAGGE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 79 0 MFAGGF+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 85 0 MFAGLE+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 91 0 MFAGLF+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 97 0 MFAGLG+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 100 0 MFAGLH+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 103 0 MFAHKE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 106 0 MFAGGE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 117 0 MFAGGF+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 123 0 MFAGLE+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 129 0 MFAGLF+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 135 0 MFAGLG+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 138 0 MFAGLH+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 141 0 RYQMUY+VnURWPalladioL Type 1 Custom yes yes yes 155 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-07-10 02:08:21 CEST RepresentationInformation: diagnostics-14-01576.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-07-09 19:25:04 CEST Size: 1399347 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 298 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methods Destination: section.2 Children: Item: Title: Study Population Destination: subsection.2.1 Item: Title: Echocardiographic Analysis Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Clinical and Echocardiographic Characteristics Destination: subsection.3.1 Item: Title: Independent Associates of Low eGFR Destination: subsection.3.2 Item: Title: Discussion Destination: section.4 Children: Item: Title: Cardiac Output and Renal Impairment Destination: subsection.4.1 Item: Title: Venous Congestion and Renal Impairment Destination: subsection.4.2 Item: Title: Clinical Implications Destination: subsection.4.3 Item: Title: Limitations Destination: subsection.4.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Right Ventricular and Right Atrial Strain Are Associated with Kidney Dysfunction in Acute Heart Failure Author: Vasileios Anastasiou, Emmanouela Peteinidou, Christos Tountas, Stylianos Daios, Dimitrios V. Moysidis, Emmanouil Fardoulis, Christos Gogos, Marieta Theodorakopoulou, Fotini Iatridi, Pantelis Sarafidis, George Giannakoulas, Theodoros Karamitsos, Victoria Delgado, Antonios Ziakas and Vasileios Kamperidis Subject: Background: In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. This study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute HF. Methods and Results: A total of 377 patients hospitalized for acute HF were prospectively evaluated. Estimated glomerular filtration rate (eGFR) on admission was measured using the 2021 Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Advanced echocardiographic assessment was performed on admission. Patients with eGFR < 45 mL/min/1.73 m2 were more likely to have chronic heart failure, chronic atrial fibrillation, and type 2 diabetes mellitus compared to patients with eGFR 45 mL/min/1.73 m2. Patients with lower eGFR had lower cardiac output, higher mean E/e’ ratio, larger right ventricular (RV) size, worse RV free wall longitudinal strain, more impaired right atrial (RA) reservoir strain, and more frequent severe tricuspid regurgitation. RV free wall longitudinal strain and RA reservoir strain were the only independent echocardiographic associates of low eGFR, whereas cardiac output was not. Conclusions: Impaired RV and RA longitudinal strain were independently associated with eGFR < 45 mL/min/1.73 m2 in acute HF, while reduced cardiac output was not. This suggests that RV and RA dysfunction underlying venous congestion and increased renal afterload are more important pathophysiological determinants of renal impairment in acute HF than reduced cardiac output. 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