Impact of increased venous pressure on kidney function and mortality in cardiovascular patients with preserved ejection fraction

Doctoral Dissertation uoadl:2928207 298 Read counter

Unit:
Faculty of Medicine
Library of the School of Health Sciences
Deposit date:
2020-11-16
Year:
2020
Author:
Milkas Anastasios
Dissertation committee:
Κωνσταντίνος Τσιούφης, Καθηγητής, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών.
Δημήτριος Τούσουλης Καθηγητής, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών.
Ελευθέριος Τσιάμης Αναπληρωτής Καθηγητής, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών.
Κωνσταντίνα Αγγέλη Καθηγητρια, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών.
Εμμανουήλ Βαβουρανάκης Καθηγητής, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών.
Γεράσιμος Σιασος Καθηγητής, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών.
Λουκιανός Ραλλίδης Καθηγητής,Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών.
Original Title:
Η συσχέτιση της νεφρικής λειτουργίας με την πίεση στο αρτηριακό δέντρο και την κεντρική φλεβική πίεση σε ασθενείς που υποβάλονται σε στεφανιογραφικό έλεγχο
Languages:
Greek
Translated title:
Impact of increased venous pressure on kidney function and mortality in cardiovascular patients with preserved ejection fraction
Summary:
Background: Right but not left ventricular hemodynamic parameters have been found to be independently associated with adverse renal outcomes in patients with acute decompensated heart failure.
Aim: To investigate the hemodynamic profile of patients without acute decompensated heart failure and LVEF>50% referred for elective left and right heart catheterization and to correlate left and right filling pressures, stroke volume and arterial blood pressure to renal function parameters. Subsequently, we tested the hypothesis that right ventricle and left ventricle hemodynamic parameters could predict all-cause mortality in our non-HF subjects.
Methods: Between October 2009 and November 2010, 151 consecutive patients referred for elective left and right heart catheterization were studied and consequently followed up for a mean period of 8 years in order to identify all-cause mortality. Patient’s initial cohort was subdivided in two groups according to right atrium pressure. The RAPRLOW group (Right Atrium Pressure≤9 mmHg) and the RAPRHIGH group (Right Atrium Pressure>9mmHg)
Results: No correlation between blood pressure, PCWP, CI, SV and SVI and parameters of kidney function was observed. However, a weak although significant correlation between RAP and MDRD (r=-0.202; p=0.014) could be detected. RAPRLOW patients had a statistical significant lower MDRD value of 16.6 ml/min/1.73 m2 than RAPRHIGH patients. Increased RAP (HR=2.03; 95% [CI]: 1.05 to 3.9; p=0.025] and age (HR=1.08, 95% [CI] 1.04-1.12, p<0.001) independently predicted all-cause mortality during follow up.
Conclusions: Our study demonstrates that right ventricular preload, affects renal function in patients with preserved systolic function and that neither aortic systolic pressure nor left ventricle pressure indices were related to eGFR. Furthermore, we demonstrated for the first time that an increased RAP is able to predict a worse prognosis in patients with preserved ejection fraction independently of well-established risk factors, such as blood pressure and stroke volume index.
Main subject category:
Health Sciences
Keywords:
Increased venous pressure , kidney function, cardiovascular mortality
Index:
No
Number of index pages:
0
Contains images:
No
Number of references:
167
Number of pages:
134
File:
File access is restricted only to the intranet of UoA.

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