J Korean Med Sci.  2024 Mar;39(8):e80. 10.3346/jkms.2024.39.e80.

Mildly Reduced Renal Function Is Associated With Increased Heart Failure Admissions in Patients With Hypertrophic Cardiomyopathy

• Bae NY
• Rhee TM
• Park CS
• Choi YJ
• Lee HJ
• Choi HM
• Park JB
• Yoon YE
• Kim YJ
• Cho GY
• Hwang IC
• Kim HK

• KMID: 2553329
• DOI: http://doi.org/10.3346/jkms.2024.39.e80

Abstract

Background
The association between renal dysfunction and cardiovascular outcomes has yet to be determined in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate whether mildly reduced renal function is associated with the prognosis in patients with HCM.
Methods
Patients with HCM were enrolled at two tertiary HCM centers. Patients who were on dialysis, or had a previous history of heart failure (HF) or stroke were excluded. Patients were categorized into 3 groups by estimated glomerular filtration rate (eGFR): stage I (eGFR ≥ 90 mL/min/1.73 m² , n = 538), stage II (eGFR 60–89 mL/min/1.73 m² , n = 953), and stage III–V (eGFR < 60 mL/min/1.73 m² , n = 265). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, hospitalization for HF (HHF), or stroke during median 4.0-year follow-up. Multivariable Cox regression model was used to adjust for covariates.
Results
Among 1,756 HCM patients (mean 61.0 ± 13.4 years; 68.1% men), patients with stage III–V renal function had a significantly higher risk of MACEs (adjusted hazard ratio [aHR], 2.71; 95% confidence interval [CI], 1.39–5.27; P = 0.003), which was largely driven by increased incidence of cardiovascular death and HHF compared to those with stage I renal function. Even in patients with stage II renal function, the risk of MACE (vs. stage I: aHR, 2.21’ 95% CI, 1.23–3.96; P = 0.008) and HHF (vs. stage I: aHR, 2.62; 95% CI, 1.23–5.58; P = 0.012) was significantly increased.
Conclusion
This real-world observation showed that even mildly reduced renal function (i.e., eGFR 60–89 mL/min/1.73 m² ) in patients with HCM was associated with an increased risk of MACEs, especially for HHF.

Keyword

Hypertrophic Cardiomyopathy; Renal Function; Glomerular Filtration Rate; Prognosis; Heart Failure

Figure

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  Fig. 1 Study flow of patients. Patients diagnosed with hypertrophic cardiomyopathy and without a previous history of HF or stroke were enrolled. MACE, a composite of CV death, hospitalization for HF, and stroke, during median 4.0 years of follow-up was analyzed according to the groups stratified by renal function (stage III–V, eGFR < 60 mL/min/1.73 m2; stage II, eGFR 60–89 mL/min/1.73 m2; and stage I, eGFR ≥ 90 mL/min/1.73 m2).eGFR = estimated glomerular filtration rate, HF = heart failure, CV = cardiovascular, MACE = major adverse cardiovascular event.

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  Fig. 2 Cumulative incidence of MACE in groups by renal function. When MACE was defined as a composite of all-cause death, hospitalization for heart failure, and stroke, the cumulative incidence of MACE was significantly higher even in patients with stage II renal function, as compared to those with stage I renal function.eGFR = estimated glomerular filtration rate, MACE = major adverse cardiovascular event.

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  Fig. 3 Risks of MACE and its individual components in each category of renal function. The number of events, cumulative incidence, and multivariable-adjusted HR with 95% CI of MACE (a composite of all-cause death, hospitalization due to HF, and stroke) and its individual outcomes are illustrated in each category of renal function with stage I as a reference.MACE = major adverse cardiovascular event, HF = heart failure, HR = hazard ratio, CI = confidence interval.aAdjusted for age ≥ 60 years, sex, body mass index ≥ 25 kg/m2, hypertension, diabetes mellitus, previous history of myocardial infarction, left ventricular ejection fraction, significant dynamic left ventricular outflow tract obstruction, systolic blood pressure, use of beta blocker, and apical type of hypertrophic cardiomyopathy.

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  Fig. 4 Subgroup analysis by age, sex, BMI, LVEF, and previous history of AF.MACE = major adverse cardiovascular event, HR = hazard ratio, CI = confidence interval, eGFR = estimated glomerular filtration rate, BMI = body mass index, AF = atrial fibrillation, LVEF = left ventricular ejection fraction, ref = reference.aAdjusted for age ≥ 60 years, sex, body mass index ≥ 25 kg/m2, hypertension, diabetes mellitus, previous history of myocardial infarction, left ventricular ejection fraction, significant dynamic left ventricular outflow tract obstruction, systolic blood pressure, use of beta blocker, and apical type of hypertrophic cardiomyopathy, except for each corresponding variable for subgroup.

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