sion (PH) in patients with left heart disease (LHD). The diastolic pulmonary ... Advanced Ischemic Versus Non-Ischemic Cardiomyopathy. C. Yen , N. Diakos, ...
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The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2014
Purpose: In the setting of heart failure (HF), it is difficult to differentiate HF-induced renal dysfunction from chronic kidney disease (CKD). It has previously been demonstrated that biomarkers such as brain natriuretic peptides (BNP) and the blood urea nitrogen to creatinine ratio (BUN/Creat) can differentiate high vs. low risk renal dysfunction. We hypothesized that a combination of these markers could further improve risk stratification and clinical phenotyping of patients with renal dysfunction and HF. Methods: 908 consecutive patients with a discharge diagnosis of HF and an admission BNP level available were reviewed. The median values were used to define elevated BNP (> 1296 pg/ml) and BUN/Creat (> 17). Results: In patients with preserved renal function, survival was similar across groups regardless of BNP level and/or BUN/Creat ratio (Adjusted p= 0.52). Moreover, patients with renal dysfunction who have both low BNP and BUN/Creat ratio were found to have similar survival outcome as patients without renal dysfunction (Adjusted HR= 0.97, 95% CI 0.71-1.4, p= 0.99). However, patients with renal dysfunction and high BNP and BUN/Creat not only had a cardiorenal profile characterized by more frequent venous congestion, diuretic resistance, hypotension, hyponatremia, longer length of stay, and greater in-hospital requirement for inotropes, but also had substantially worse survival outcomes (Adjusted HR= 1.9, 95% CI 1.5-2.5, p 15, and DPG ≥ 7 mmHg); 2) Ipc-PH (mean PAP ≥ 25, PAWP> 15, DPG
