#1800 Cardiorenal relationships: correlation analysis of the effect of metabolic syndrome components on renal and cardiac function in heart failure patients with mid-range ejection fraction

Abstract Background and Aims An independent inverse relationship was found between eGFR <60 ml/min/1.73 m2 and an increased risk of death, cardiovascular outcomes, and hospitalization. The incidence of new cardiovascular complications is 4.8% in patients with stage 2 CKD and almost doubles in stages 3–4. The risk of developing adverse cardiovascular outcomes in patients on dialysis or in kidney transplant recipients is tens of times higher than in the general population. Aim was to study the nature of the relationships between the glomerular filtration rate (GFR), carbohydrate and lipid metabolism parameters (glucose, TG), body mass index (BMI), blood pressure (BP) and parameters of systolic and diastolic function of the left ventricle (LV) in patients with HFmrEF with different representations of metabolic syndrome (MS) components. Method 97 male patients with chronic heart failure (CHF) of ischemic genesis, functional class (FC) II–III according to NYHA, aged 40–60 years, with a history of myocardial infarction from 6 months to 5 years were examined. Depending on the presence of MS components, 3 groups of patients were identified: Group I (n = 70), patients without MS (CHF FC II—38, CHF FC III—32 patients); Group II (n = 67) patients with various combinations of dyslipidemia (HDL-C <1.03 mmol/l; LDL-C >3.0 mmol/l) with abdominal obesity (AO), hypertension and hypertriglyceridemia (HTG) (CHF FC II—35, CHF FC III—32 patients); Group III (n = 60) patients with various combinations of dyslipoproteinemia (DLP) and type 2 diabetes mellitus (DM2) with AO, hypertension and hypertriglyceridemia (HTG) (CHF FC II—26, CHF FC III—34 patients). According to the classification of CHF (ESC 2016), depending on the level of ejection fraction (EF), all examined patients with CHF were also divided into subgroups: with normal (preserved EF)—EF ≥50% (HFpEF) and mid-range EF (gray zone)—EF = 40%–49% (HFmrEF). Thus, in group I of patients with CHF without MS, 42 had preserved EF and 28 patients had mid-range EF, in group II, 39 patients had preserved EF, 28 patients with CHF mid-range EF, and in group III, 28 had preserved EF and 32 had mid-range EF. All examined patients (HFmrEF, EF 40%–49%) were divided into three groups: without MS (group I), with MS (group II), and with MS in combination with T2DM (group III). The following parameters were assessed: eGFR (using the calculation formula or creatinine clearance), TG, glucose, BP, BMI, and echocardiography parameters (EF, IVRT, E/A ratio, RE/RA). Correlation analysis was performed to identify significant relationships between cardiac and renal parameters. Results In the group without MS (I), statistically significant inverse relationships were found between eGFR and TG, glucose, BMI (r = –0.46 to –0.49; P < 0.01) and positive relationships with EF (r = 0.58; P < 0.01) and endothelial-dependent vasodilation (r = 0.69; P < 0.001). In the presence of MS (group II), the most pronounced positive correlation of eGFR with EF (r = 0.72; P < 0.001) and negative relationships with BP (r = –0.42; P < 0.01) and BMI (r = –0.39; P < 0.05) were observed. In combination with MS and T2DM (group III), the strongest negative relationships of eGFR with TG (r = –0.63; P < 0.001) and glucose (r = –0.74; P < 0.001) were recorded, as well as a positive correlation with the LV diastolic function index (RE/RA) (r = 0.49; P < 0.01). Conclusion (1) The parameters of cardiac (systolic and diastolic) and renal function are closely interrelated with the components of MS (hypertriglyceridemia, arterial hypertension, hyperglycemia, obesity). (2) Deterioration of metabolic status (especially when combined with type 2 diabetes) is accompanied by a significant decrease in eGFR and an increased risk of cardiorenal complications, which should be taken into account in the treatment and dynamic monitoring of patients with HFmrEF.

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