Prognostication of the clinical course of heart failure in elderly patients having chronic kidney disease


DOI: https://dx.doi.org/10.18565/therapy.2021.9.85-94

Larina V.N., Lunev V.I., Larin V.G., Golovko M.G., Sidorova V.P.

1) N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow; 2) Diagnostic Clinical Center No. 1 of the Moscow Department of Healthcare, Moscow
Abstract. Chronic kidney disease (CKD) has pathogenetic mechanisms of development similar with chronic heart failure (CHF) and occupies a leading place in the structure of concomitant pathology in patients with that cardiovascular disease.
Aim of the research is to estimate the prognostic significance of the index of left ventricular global function (LV IGF) in elderly patients having CHF and CKD and supervised in an outpatient conditions.
Material and methods. The study included 85 patients: the main group consisted of 59 patients with CKD and CHF (46% of male patients) aged 76 (75–80) years; comparison group – 26 with CHF, but without CKD (38% of males) at the age of 76 (72–79) years. LV IGF (%) was calculated using the formula: (LV stroke volume/LV global volume) × 100.
Results. In the main group, the value of LV IGF was 19.3 (16,6–21,5)%, in the comparison group – 20.1 (16,7–23,0)%. With an increase of CKD stage, a tendency towards a decrease in the value of LV IGF was recorded. During the follow-up period of 36 (20–40) months, 44 (74,6%) patients of the main group were hospitalized. The optimal value of LV IGF for predicting hospitalization in patients of the main group was ≤20,3% (area under the curve 0,685±0,071; 95% CI: 0,55–0,82; p=0,034); sensitivity – 63,6%, specificity – 66,7%. The optimal value of LV IHF for predicting mortality in patients of the main group was ≤19,2% (area under the curve 0,678±0,082; 95% CI: 0,52–0,84; p=0,035; sensitivity – 66,7%, specificity – 65,7%.
Conclusion. With an increase of the FC of CHF and the stage of CKD, a tendency towards LV IGF decrease was observed. The cut-off value of LV IHF for predicting hospitalization in patients 70 years of age and older with CHF and CKD was ≤20,3%, for predicting a lethal outcome – ≤19,2%.
Keywords: index of global left ventricular function, hospitalizations, left ventricular ejection fraction, echocardiography, chronic heart failure, chronic kidney disease, mortality
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About the Autors

Vera N. Larina, MD, professor, head of the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova Str. Tel.: +7 (910) 473-35-66. E-mail: larinav@mail.ru. ORCID: 0000-0001-7825-5597
Viktor I. Lunev, postgraduate student, assistant at the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova Str. Tel.: +7 (918) 105-27-33. E-mail: sandvit@ya.ru. ORCID: 0000-0001-9002-7749
Vladimir G. Larin, PhD, associate professor, associate professor of the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova Str. Tel.: +7 (910) 477-71-80. E-mail: larinvladimir@mail.ru. ORCID: 0000-0001-7152-0896
Milada G. Golovko, PhD, associate professor, associate professor of the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova Str. Tel.: +7 (916) 519-17-78. E-mail: golovko_mg@rsmu.ru. ORCID: 0000-0003-2196-6739
Vera P. Sidorova, PhD, chief physician of Diagnostic Clinical Center No. 1 of the Moscow Department of Healthcare. Address: 117485, Moscow, 29/2 Miklukho-Maclay Str. E-mail: kdc1@zdrav.mos.ru. ORCID: 0000-0001-6534-7847


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