Cardiac Mechanics and Kidney Function Decline in the Cardiovascular Health Study

Rupal Mehta; Petra Buzkova; Harnish Patel; Jeanette Cheng; Jorge R. Kizer; John S. Gottdiener; Bruce Psaty; Sadiya S. Khan; Joachim H. Ix; Tamara Isakova; Michael G. Shlipak; Nisha Bansal; Sanjiv J. Shah

doi:10.34067/KID.0000000000000100

Cardiac Mechanics and Kidney Function Decline in the Cardiovascular Health Study

Rupal Mehta^*, Petra Buzkova, Harnish Patel, Jeanette Cheng, Jorge R. Kizer, John S. Gottdiener, Bruce Psaty, Sadiya S. Khan, Joachim H. Ix, Tamara Isakova, Michael G. Shlipak, Nisha Bansal, Sanjiv J. Shah

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

BackgroundClinical heart failure frequently coexists with CKD and may precipitate kidney function decline. However, whether earlier-stage myocardial dysfunction assessable by speckle-tracking echocardiography (STE) is a contributor to kidney function decline remains unknown.MethodsWe studied 2135 Cardiovascular Health Study participants who were free of clinical heart failure and had year 2 baseline 2D-STE and two measurements of eGFR (year 2 and year 9). "Archival" speckle tracking of digitized echocardiogram videotapes was used to measure left ventricular longitudinal strain (LVLS), LV early diastolic strain rate (EDSR), left atrial reservoir strain (LARS), right ventricular free wall strain (RVFWS), and mitral annular velocity (e′). Multivariable Poisson regression models that adjusted for demographics and cardiovascular risk factors (RFs) were used to investigate the independent associations of cardiac mechanics indices and decline in kidney function defined as a 30% decline in eGFR over 7 years.ResultsIn RF models, LVLS, EDSR, RVFWS, and e′ were all significantly associated with the prevalence of kidney disease. After multivariable adjustment, left atrial dysfunction (relative risk [RR], 1.18; 95% confidence interval [CI], 1.01 to 1.38 per SD lower LARS) and left ventricular diastolic dysfunction (RR, 1.21; 95% CI, 1.04 to 1.41 per SD lower EDSR) were each significantly associated with 30% decline in eGFR.ConclusionsSubclinical myocardial dysfunction suggesting abnormal diastolic function detected by 2D-STE was independently associated with decline in kidney function over time. Further studies are needed to understand the mechanisms of these associations and to test whether interventions that may improve subclinical myocardial dysfunction can prevent decline of kidney function.

Original language	English (US)
Pages (from-to)	622-630
Number of pages	9
Journal	Kidney360
Volume	4
Issue number	5
DOIs	https://doi.org/10.34067/KID.0000000000000100
State	Published - May 1 2023

Funding

This research was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, 75N92021D00006, and grants U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org . This study was also supported by grants P30DK114857, K23HL150236 (RM), R01DK102438 (TI), U54 HL160273 (SJS), R01 HL107577 (SJS), R01 HL127028 (SJS), R01 HL140731 (S.J. Shah), and R01 HL149423 (S.J. Shah), American Heart Association #16SFRN28780016 (S.J. Shah) and #19TPA34890060 (S.S. Khan). Research reported in this publication was also supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number KL2TR001424. Acknowledgments This research was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, 75N92021D00006, and grants U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. This study was also supported by grants P30DK114857, K23HL150236 (RM), R01DK102438 (TI), U54 HL160273 (SJS), R01 HL107577 (SJS), R01 HL127028 (SJS), R01 HL140731 (S.J. Shah), and R01 HL149423 (S.J. Shah), American Heart Association 16SFRN28780016 (S.J. Shah) and 19TPA34890060 (S.S. Khan). Research reported in this publication was also supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number KL2TR001424.

Keywords

cardiac mechanics
diastolic dysfunction
heart failure
kidney disease

ASJC Scopus subject areas

Nephrology
Medicine (miscellaneous)
General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.34067/KID.0000000000000100

Cite this

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title = "Cardiac Mechanics and Kidney Function Decline in the Cardiovascular Health Study",

abstract = "BackgroundClinical heart failure frequently coexists with CKD and may precipitate kidney function decline. However, whether earlier-stage myocardial dysfunction assessable by speckle-tracking echocardiography (STE) is a contributor to kidney function decline remains unknown.MethodsWe studied 2135 Cardiovascular Health Study participants who were free of clinical heart failure and had year 2 baseline 2D-STE and two measurements of eGFR (year 2 and year 9). {"}Archival{"} speckle tracking of digitized echocardiogram videotapes was used to measure left ventricular longitudinal strain (LVLS), LV early diastolic strain rate (EDSR), left atrial reservoir strain (LARS), right ventricular free wall strain (RVFWS), and mitral annular velocity (e′). Multivariable Poisson regression models that adjusted for demographics and cardiovascular risk factors (RFs) were used to investigate the independent associations of cardiac mechanics indices and decline in kidney function defined as a 30% decline in eGFR over 7 years.ResultsIn RF models, LVLS, EDSR, RVFWS, and e′ were all significantly associated with the prevalence of kidney disease. After multivariable adjustment, left atrial dysfunction (relative risk [RR], 1.18; 95% confidence interval [CI], 1.01 to 1.38 per SD lower LARS) and left ventricular diastolic dysfunction (RR, 1.21; 95% CI, 1.04 to 1.41 per SD lower EDSR) were each significantly associated with 30% decline in eGFR.ConclusionsSubclinical myocardial dysfunction suggesting abnormal diastolic function detected by 2D-STE was independently associated with decline in kidney function over time. Further studies are needed to understand the mechanisms of these associations and to test whether interventions that may improve subclinical myocardial dysfunction can prevent decline of kidney function.",

keywords = "cardiac mechanics, diastolic dysfunction, heart failure, kidney disease",

author = "Rupal Mehta and Petra Buzkova and Harnish Patel and Jeanette Cheng and Kizer, {Jorge R.} and Gottdiener, {John S.} and Bruce Psaty and Khan, {Sadiya S.} and Ix, {Joachim H.} and Tamara Isakova and Shlipak, {Michael G.} and Nisha Bansal and Shah, {Sanjiv J.}",

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month = may,

day = "1",

doi = "10.34067/KID.0000000000000100",

language = "English (US)",

volume = "4",

pages = "622--630",

journal = "Kidney360",

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publisher = "Lippincott Williams and Wilkins",

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T1 - Cardiac Mechanics and Kidney Function Decline in the Cardiovascular Health Study

AU - Mehta, Rupal

AU - Buzkova, Petra

AU - Patel, Harnish

AU - Cheng, Jeanette

AU - Kizer, Jorge R.

AU - Gottdiener, John S.

AU - Psaty, Bruce

AU - Khan, Sadiya S.

AU - Ix, Joachim H.

AU - Isakova, Tamara

AU - Shlipak, Michael G.

AU - Bansal, Nisha

AU - Shah, Sanjiv J.

PY - 2023/5/1

Y1 - 2023/5/1

N2 - BackgroundClinical heart failure frequently coexists with CKD and may precipitate kidney function decline. However, whether earlier-stage myocardial dysfunction assessable by speckle-tracking echocardiography (STE) is a contributor to kidney function decline remains unknown.MethodsWe studied 2135 Cardiovascular Health Study participants who were free of clinical heart failure and had year 2 baseline 2D-STE and two measurements of eGFR (year 2 and year 9). "Archival" speckle tracking of digitized echocardiogram videotapes was used to measure left ventricular longitudinal strain (LVLS), LV early diastolic strain rate (EDSR), left atrial reservoir strain (LARS), right ventricular free wall strain (RVFWS), and mitral annular velocity (e′). Multivariable Poisson regression models that adjusted for demographics and cardiovascular risk factors (RFs) were used to investigate the independent associations of cardiac mechanics indices and decline in kidney function defined as a 30% decline in eGFR over 7 years.ResultsIn RF models, LVLS, EDSR, RVFWS, and e′ were all significantly associated with the prevalence of kidney disease. After multivariable adjustment, left atrial dysfunction (relative risk [RR], 1.18; 95% confidence interval [CI], 1.01 to 1.38 per SD lower LARS) and left ventricular diastolic dysfunction (RR, 1.21; 95% CI, 1.04 to 1.41 per SD lower EDSR) were each significantly associated with 30% decline in eGFR.ConclusionsSubclinical myocardial dysfunction suggesting abnormal diastolic function detected by 2D-STE was independently associated with decline in kidney function over time. Further studies are needed to understand the mechanisms of these associations and to test whether interventions that may improve subclinical myocardial dysfunction can prevent decline of kidney function.

AB - BackgroundClinical heart failure frequently coexists with CKD and may precipitate kidney function decline. However, whether earlier-stage myocardial dysfunction assessable by speckle-tracking echocardiography (STE) is a contributor to kidney function decline remains unknown.MethodsWe studied 2135 Cardiovascular Health Study participants who were free of clinical heart failure and had year 2 baseline 2D-STE and two measurements of eGFR (year 2 and year 9). "Archival" speckle tracking of digitized echocardiogram videotapes was used to measure left ventricular longitudinal strain (LVLS), LV early diastolic strain rate (EDSR), left atrial reservoir strain (LARS), right ventricular free wall strain (RVFWS), and mitral annular velocity (e′). Multivariable Poisson regression models that adjusted for demographics and cardiovascular risk factors (RFs) were used to investigate the independent associations of cardiac mechanics indices and decline in kidney function defined as a 30% decline in eGFR over 7 years.ResultsIn RF models, LVLS, EDSR, RVFWS, and e′ were all significantly associated with the prevalence of kidney disease. After multivariable adjustment, left atrial dysfunction (relative risk [RR], 1.18; 95% confidence interval [CI], 1.01 to 1.38 per SD lower LARS) and left ventricular diastolic dysfunction (RR, 1.21; 95% CI, 1.04 to 1.41 per SD lower EDSR) were each significantly associated with 30% decline in eGFR.ConclusionsSubclinical myocardial dysfunction suggesting abnormal diastolic function detected by 2D-STE was independently associated with decline in kidney function over time. Further studies are needed to understand the mechanisms of these associations and to test whether interventions that may improve subclinical myocardial dysfunction can prevent decline of kidney function.

KW - cardiac mechanics

KW - diastolic dysfunction

KW - heart failure

KW - kidney disease

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ER -

Cardiac Mechanics and Kidney Function Decline in the Cardiovascular Health Study

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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