Emre Demir

and 7 more

Introduction: Renal dysfunction in heart failure (HF) patients is associated with poor outcomes. Reduced cardiac index (CI) and right atrial pressure (RAP) are postulated to be a contributor the renal dysfunction. This study aimed to investigate the relationship between the estimated glomerular filtration rate (eGFR) and the pulmonary artery catheterization (PAC) results. Patients and Method: Hospitalized advanced HF patients, between 2016-2020 PAC performed included in the study. Renal dysfunction was defined as eGFR<60 ml/min/1.73 m 2. We evaluated the correlation and the linear regression models of hemodynamics with eGFR. Results: 181 patients were included in the study, and the mean left ventricular ejection fraction (LVEF) was 20.9±3.7%, the mean eGFR was 79.8±25.4 ml/min/1.73 m 2, and 22.7% of patients had eGFR lower than 60 ml/min/1.73 m 2. CI (1.85±0.72; 1.84±0.64; p=0.47, respectively) and RAP (13.1±6.6; 13.7±6.8; p=0.61,respectively) was not significantly associated with renal dysfunction in HF patients. In the multivariable model, smoking history, AF, body mass index (BMI) revealed negative relation with eGFR, continuing ACEi or ARB therapy, and pulmonary artery capacitance index(PAC-i) were positively related variables with eGFR (p<0.0001). eGFR was not significantly different in distinct tricuspid regurgitation severities (p=0.67); however, eGFR was non-significantly higher in patients with moderate tricuspid regurgitation. In patients with moderate tricuspid regurgitation, eGFR had an inverse relationship with the RVSW-i and TRVP-i. Conclusion: These results indicate that CI or RAP is not the primary driver for eGFR. PAC-i and continuing ACEi or ARB positively, AF, smoking history, and BMI were negatively related factors for reduced eGFR.

Emre Demir

and 12 more

Objective: Peripartum cardiomyopathy (PPCM) diagnosis made by excluding identifiable causes of heart failure (HF) and occurs end of the pregnancy or during the postpartum period of five months. It presents a clinical HF spectrum with left ventricular systolic dysfunction. Background: The purpose of this study is to retrospectively evaluate the clinical characteristics, cardiac magnetic resonance (CMR) imaging features, and end-points consisting of left ventricle recovery, left ventricular assist device implantation, heart transplantation, and all-cause mortality. Method: Outpatient HF records between 2008 to 2021 were screened. Thirty-seven patients were defined as PPCM. Twenty-five patients had CMR evaluation at the time of diagnosis, and six patients were re-evaluated with CMR. Results: The mean age was 30.5±5.6 years, and the mean LVEF was 28.2±6.7%. In thirteen(35.7%) patients, LVEF recovered during the follow-up course. The median recovery time was 281(IQR [78-358]) days. LVEF on CMR was 35.3±10.5, and three patients exhibited late gadolinium enhancement(LGE) patterns. Sub-endocardial and mid-wall uptake pattern types were detected. 18(75%) patients met the Petersen left ventricle non-compaction cardiomyopathy(LVNC) criteria. Patients with NC/C ratio lower than 2.3 had lower LVEDVi and LVESVi (124.9±35.4,86.4±7.5, p=0.003;86.8±34.6,52.6±7.6, p=0.006), respectively. The median follow-up time was 2129 (IQR [911-2634]) days. The primary endpoint-free one-year survival was 88.9%(event rate 11.1%), and five-year survival was 75.7%(event rate 24.3%). Conclusion: In a retrospective cohort of PPCM patients, 35.7% of patients’ LVEF recovered, and the primary end-point of free-five-year survival was 75%. Twenty-five patients were assessed with CMR; three of four met the Petersen CMR-derived LVNC at initial evaluation.