The Impact of Aortic Pulsatile Hemodynamics on Renal Function Trajectories in Acute Heart Failure

Abstract BACKGROUND Perturbation of aortic pulsatile hemodynamics and the presence of impaired renal function (IRF) may increase postdischarge events in patients hospitalized for acute heart failure (AHF). The present study investigated whether on-admission aortic pulsatile hemodynamics is associated with IRF and in-hospital changes in renal function, and modulates its impact on postdischarge adverse events in patients with AHF. METHODS A total of 240 AHF patients (69.3 ± 15.6 years, 76.7% men) were enrolled and followed for outcomes of heart failure hospitalization and death up to 3 years after discharge. Measures of renal function and aortic pulsatile hemodynamics, including carotid-femoral pulse wave velocity (cf-PWV) and the amplitude of the reflected wave (Pb), were obtained within 24 h of admission and before discharge. IRF was defined by an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² RESULTS On admission, 159 patients (66.3%) presented with IRF. At discharge, eGFR significantly improved by 6.6 ± 13.4 ml/min/1.73m² (19.3 ± 44.7%, P < 0.001) in patients with on-admission IRF. Increased on-admission aortic pulsatile hemodynamics was significantly associated with the presence of IRF and inversely associated with the in-hospital improvement of eGFR. Persistent IRF on both admission and discharge (hazard ratio 1.579, 95% CI 1.078–2.315), change of eGFR per 1 standard deviation increment (0.747, 0.597–0.934), and over 30% improvement of eGFR (0.492, 0.306–0.792) were significantly predictive of postdischarge events in multivariable Cox models incorporating either cf-PWV or Pb. CONCLUSIONS On-admission aortic pulsatile hemodynamics was significantly associated with IRF and in-hospital changes in renal function in patients with AHF, and both were significantly associated with postdischarge adverse events independent of aortic pulsatile hemodynamics.