Association of diastolic and renal dysfunctions in non-ST segment elevation acute coronary syndrome patients with heart failure with preserved ejection fraction and their impact on outcomes

Objective:The presence and progression of renal dysfunction can increase the incidence of cardiovascular complications and increase the risk of mortality in patients with heart failure and acute coronary syndrome.The aim of the study was to explore association of renal and left ventricular diastolic (LVDD) dysfunctions in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) with heart failure with preserved LV ejection fraction (HFpEF) and their impact on outcomes.Methods: The study included 58 patients with NSTE-ACS and HFpEF, who were divided depending on the type of LVDD into 2 groups: the 1 st group included patients with LVDD grade I (n=33), the 2 nd group included patients with LV DD grade II (n=25).Glomerular filtration rate, daily microalbuminuria and daily protein excretion were calculated, and echocardiographic examination was performed at the time of admission to the hospital and 3 months after discharge from the hospital.In addition, coronary angiography was performed during the hospitalization period.Results: Renal dysfunction was found in 49 (84.48%)patients with NSTE-ACS with HFpEF.In the group 1, renal dysfunction was detected in 26 (78.8%) (95% CI 71.2%; 88.8%) cases, while in the 2 nd group renal dysfunction occurred even more often -in 23 (92.0%) (95% CI 80.7%; 105.8%) patients (p<0.0001).Indicators of renal function significantly correlated with all indicators of LV diastolic function.Predictors of reduced renal function are echocardiographic parameters of LVDD, the size of the left atrium, N-terminal pro b-type natriuretic peptide (NT-proBNP) and an increase in the end-systolic area of the right ventricle.During a prospective observation of patients with NSTE-ACS with HFpEF in the third month, chronic kidney disease (CKD) developed in 26 (44.83%) patients.In the 1 st group of patients CKD was detected in 3 (9.1%)(95% CI 3.1%; 23.1%), and in the 2 nd group -in 23 (92%) (95% CI 80.7%; 105.8%) of patients (p<0.0001).A prospective three-month follow-up revealed the development of CKD, the rate of re-hospitalization was 11.4% (95% CI 0.8%; 22.0%, p=0.021), while HF symptoms worsened in 14.3% (95% CI 3.3%; 26.5%, p=0.008).CKD had an adverse impact on outcomes in patients with NSTE-ACS and HFpEF, as evidenced by an increased risk of re-hospitalization (odds ratio [OR] 2.474, 95% CI 1.748-3.500,p<0.0001), recurrence of ACS (OR 2.120, 95% CI 1.594-2.819,p<0.024), and progression of HF (OR 2.647, 95% CI 1.819-3.851,p<0.0001).Our study found that prognostically significant indicators of readmission and recurrent ACS are estimated glomerular filtration rate and NT-proBNP levels, and possible progression of HF is predicted by the level of daily microalbuminuria.The results of coronary angiography showed a tendency to differences in the groups of patients with NSTE-ACS with HFpEF.Conclusion: Renal function indicators in patients with NSTE ACS with HFpEF are significantly associated with diastolic parameters of the left ventricle and depend on the severity of diastolic dysfunction of the left ventricle.Predictors of readmission, recurrence of acute coronary syndrome, and progression of chronic heart failure are glomerular filtration rate, daily microalbuminuria, daily proteinuria, and left ventricular end-diastolic volume.