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Abstract: TH-PO612

The Association of Ejection Fraction With Cardiac Arrest and Myocardial Infarction Differs by eGFR

Session Information

Category: Hypertension and CVD

  • 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Ravi, Katherine Scovner, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Mavrakanas, Thomas, McGill University, Montreal, Quebec, Canada
  • Khattak, Aisha, The University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Singh, Karandeep, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Charytan, David M., New York University School of Medicine, New York, New York, United States
  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

Advanced chronic kidney disease (CKD) and left ventricular (LV) systolic dysfunction are potent risk factors for cardiovascular events. Here we explore if the association of LV ejection fraction (EF) with cardiac arrest, myocardial infarction (MI), ischemic stroke, and all-cause mortality differs by eGFR across earlier stages of CKD.

Methods

Using registry data from 2004-2014 from five Mass General Brigham hospitals, we performed an observational cohort study of 17,962 patients with eGFR 30-90mL/min/1.73m2. Cardiovascular outcomes were ascertained from ICD-9 codes. Cox regression models, incorporating an interaction term for continuous eGFR and LVEF, were fit and adjusted for age, sex, race, hypertension, diabetes mellitus, coronary artery disease, and left ventricular mass index.

Results

Mean age was 67 years, and 51% were male. The mean eGFR was 66±16 mL/min/1.73m2 and LVEF 54±13%. Over a median of 0.96 (0.14-4.84) years there were 437 cardiac arrests, 4,634 MIs, 1,549 ischemic strokes, and 6,282 deaths. The association of LVEF with cardiac arrest differed according to eGFR (P-interaction <0.01). While there was no evidence of association of LVEF with cardiac arrest in the lowest quartile of eGFR (adjusted hazard ratio (aHR) 1.02; 95% CI 0.92-1.13), for each 5% increase in LVEF there was a 21% lower risk of cardiac arrest in the highest quartile of eGFR (aHR 0.79; 95% CI 0.66-0.94; Table). The association of LVEF with MI also decreased as eGFR declined (Table). There was no evidence of effect modification of LVEF by eGFR for ischemic stroke or mortality (P-interaction >0.3 for both).

Conclusion

Among patients with eGFR 30-90mL/min/1.73m2, the association of LVEF with cardiac arrest disappears at lower (vs. higher) levels of kidney function and is less pronounced for MI at lower (vs. higher) levels of kidney function. Further research is required to elucidate what factors beyond LVEF drive these outcomes in the setting of more advanced kidney disease.

Funding

  • NIDDK Support