Background -Renal impairment is an emerging prognostic indicator in heart failure(HF) patients. Despite known racial differences in the progression of both HF and renal disease, it is unclear whether the prognosis for...Background -Renal impairment is an emerging prognostic indicator in heart failure(HF) patients. Despite known racial differences in the progression of both HF and renal disease, it is unclear whether the prognosis for renal impairment in HF patients differs by race. We sought to determine in HF patients the 1-year mortality risks associated with elevated creatinine and impaired estimated glomerular filtration rate(eGFR) and to quantify racial differences in mortality. Methods and Results -We retrospectively evaluated the National Heart Care Project nationally representative cohort of 53 640 Medicare patients hospitalized with HF. Among 5669 black patients, mean creatinine was 1.6±0.9mg/dL, and 54%had an eGFR ≤60, compared with creatinine 1.5±0.7 mg/dL and 68%eGFR ≤60 in 47 971 white patients. Higher creatinine predicted increased mortality risk, although the magnitude of risk differed by race(interaction P=0.0001). Every increase in creatinine of 0.5 mg/dL was associated with a >10%increased risk in adjusted mortality for blacks, compared with >15%increased risk in whites(interaction P=0.0001), with the most striking racial disparities at the highest levels of renal impairment. Depressed eGFR showed similar racial differences(interaction P=0.0001). Conclusions -Impaired renal function predicts increased mortality in elderly HF patients, although risks are more pronounced in whites. Distinct morbidity and mortality burdens in black versus white patients underscore the importance of improving patient risk-stratification, defining optimal therapies, and exploring physiological underpinnings of racial differences.展开更多
We performed a cross-sectional study to evaluate the association of anemia with diastolic dysfunction and left ventricular hypertrophy(LVH) in outpatients who had coronary artery disease. Logistic regression was used ...We performed a cross-sectional study to evaluate the association of anemia with diastolic dysfunction and left ventricular hypertrophy(LVH) in outpatients who had coronary artery disease. Logistic regression was used to examine the association of blood hemoglobin(Hb) concentrations with diastolic dysfunction and LVH in 822 participants in the Heart and Soul Study who had normal sinus rhythm and preserved systolic function(left ventricular ejection fraction< 50%). Using transthoracic echocardiography, diastolic dysfunction was defined as diastolically dominant pulmonary vein flow, and LVH was defined as left ventricular mass index >90 g/m2. Anemia(Hb< 13 g/dl) was present in 24%of participants(197 of 822). The prevalence of diastolic dysfunction ranged from 8%in participants who did not have anemia(Hb< 13 g/dl) to 13%in those who had moderate anemia(Hb 11 to 13 g/dl) to 24%in those who had severe anemia(Hb< 11 g/dl, p=0.004 for trend). After multivariable adjustment, moderate anemia(odds ratio [OR] 2.0, 95%confidence interval [CI] 1.1 to 3.6) and severe anemia(OR 6.6, 95%CI 1.9 to 24.9) remained strongly associated with diastolic dysfunction. In contrast, moderate anemia(OR 1.4, 95%CI 1.0 to 2.1) and severe anemia(OR 1.6, 95%CI 0.6 to 4.6) were not significantly associated with LVH.We found anemia to be strongly associated with diastolic dysfunction but not with LVH in this community-based sample of outpatients who had established coronary disease.展开更多
文摘Background -Renal impairment is an emerging prognostic indicator in heart failure(HF) patients. Despite known racial differences in the progression of both HF and renal disease, it is unclear whether the prognosis for renal impairment in HF patients differs by race. We sought to determine in HF patients the 1-year mortality risks associated with elevated creatinine and impaired estimated glomerular filtration rate(eGFR) and to quantify racial differences in mortality. Methods and Results -We retrospectively evaluated the National Heart Care Project nationally representative cohort of 53 640 Medicare patients hospitalized with HF. Among 5669 black patients, mean creatinine was 1.6±0.9mg/dL, and 54%had an eGFR ≤60, compared with creatinine 1.5±0.7 mg/dL and 68%eGFR ≤60 in 47 971 white patients. Higher creatinine predicted increased mortality risk, although the magnitude of risk differed by race(interaction P=0.0001). Every increase in creatinine of 0.5 mg/dL was associated with a >10%increased risk in adjusted mortality for blacks, compared with >15%increased risk in whites(interaction P=0.0001), with the most striking racial disparities at the highest levels of renal impairment. Depressed eGFR showed similar racial differences(interaction P=0.0001). Conclusions -Impaired renal function predicts increased mortality in elderly HF patients, although risks are more pronounced in whites. Distinct morbidity and mortality burdens in black versus white patients underscore the importance of improving patient risk-stratification, defining optimal therapies, and exploring physiological underpinnings of racial differences.
文摘We performed a cross-sectional study to evaluate the association of anemia with diastolic dysfunction and left ventricular hypertrophy(LVH) in outpatients who had coronary artery disease. Logistic regression was used to examine the association of blood hemoglobin(Hb) concentrations with diastolic dysfunction and LVH in 822 participants in the Heart and Soul Study who had normal sinus rhythm and preserved systolic function(left ventricular ejection fraction< 50%). Using transthoracic echocardiography, diastolic dysfunction was defined as diastolically dominant pulmonary vein flow, and LVH was defined as left ventricular mass index >90 g/m2. Anemia(Hb< 13 g/dl) was present in 24%of participants(197 of 822). The prevalence of diastolic dysfunction ranged from 8%in participants who did not have anemia(Hb< 13 g/dl) to 13%in those who had moderate anemia(Hb 11 to 13 g/dl) to 24%in those who had severe anemia(Hb< 11 g/dl, p=0.004 for trend). After multivariable adjustment, moderate anemia(odds ratio [OR] 2.0, 95%confidence interval [CI] 1.1 to 3.6) and severe anemia(OR 6.6, 95%CI 1.9 to 24.9) remained strongly associated with diastolic dysfunction. In contrast, moderate anemia(OR 1.4, 95%CI 1.0 to 2.1) and severe anemia(OR 1.6, 95%CI 0.6 to 4.6) were not significantly associated with LVH.We found anemia to be strongly associated with diastolic dysfunction but not with LVH in this community-based sample of outpatients who had established coronary disease.
