The prevalence of type 2 cardiorenal syndrome in chronic stable heart failure patients

Introduction: Cardiac and renal disorders frequently coexist in the same patient in the acute or chronic sta-tus. Observational and clinical studies have shown that acute / chronic cardiac disease can directly contribute to acute / chronic worsening of renal disease and vice versa. The risk of chronic renal disease in heart failure (HF) is not well established, but type 2 cardiac syndro-me (T2 CRS) is very common HF patients and is asso-ciated with a poor prognosis.
Objective: To assess the prevalence of type 2 cardio-renal syndrome in chronic stable heart failure patients with ejection fraction ≤49%.
Methods: T his observational cohort study included 145 patients with reduced ejection fraction HF. Rou-tine EKG, echocardiography, biochemistry, including Cystatine C, NT-proBNP, proteinuria were measured. Glomerular filtration rate (GFR) was estimated by the CKD-EPI CYSTATIN C based formula adjusted for Body Surface Area. We divided patients into two groups with/without T2 CRS according to eGFR.
Results: Among 145 adult participants, 78 subjects (40 males/38 females) aged 68.24±1.13 years had T2 CRS (eGFR <60 ml/min); 67 patients (45 males/22 females) with mean age 61.48±1.0 years without T2 CRS (eGFR ≥60 ml/min). In patients with reduced eGFR EF was found to be 40.52±0.85%; NT-proBNP – 5243.29±770.2 pg/ml; Cystatine C of 1.81±0.06 mg/l; proteinuria – 0.16±0.04 g/l, mean eGFR 41.77±1.44 ml/min; Body Mass Index (BMI) 32.13 kg/m2. The mean hospital stay for CRS patients was 12.59 days and the lenght of the pre-existing cardiac disease was 15.27 years. Distribution by HF severity: 15 patients (19%) had HF FC II NYHA, 43 (55.13%) – HF FC III NYHA; 20 (25.6%) – HF FC IV NYHA. Patients without CRS had an EF of 40.03±0.92%; NT-proBNP 3012.9±519.37 pg/ml; Cistatine C of 1.27±0.12 mg/l; proteinuria level – 0.24±0.08 g/l, mean eGFR 79.81±2.28 ml/min; body mass index (BMI) 32.25 kg/m2. The mean hospital stay for non- CRS patients was 11.33 days and the length of pre-existing cardiac disease was 12.41 years. Distribu-tion by HF severity, 13 patients (19.4%) had HF FC II NYHA, 46 (68.65%) – HF FC III NYHA; 8 (11.9%) – HF FC IV NYHA.
Conclusions: Study data revealed an increased pre-valence of type 2 CRS (53.79%) in patients with stable chronic HF with ejection fraction ≤49%. Despite the similar ejection fraction and body mass index betwe-en groups, CRS patients were gravely: with higher NT-proBNP level, higher rate of HF FC IV NYHA and lon-ger hospital stay.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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