02760nas a2200265 4500008004100000022001400041245008600055210006900141260001600210520197300226100001702199700002102216700001902237700002002256700002002276700002402296700001702320700002002337700001902357700002002376700002402396700001802420700002002438856003602458 2023 eng d a2641-765000aCardiac Mechanics and Kidney Function Decline in the Cardiovascular Health Study.0 aCardiac Mechanics and Kidney Function Decline in the Cardiovascu c2023 Mar 083 a

BACKGROUND: Clinical heart failure frequently coexists with chronic kidney disease (CKD) and may precipitate kidney function decline. However, whether earlier-stage myocardial dysfunction assessable by speckle tracking echocardiography is a contributor to kidney function decline remains unknown.

METHODS: We studied 2135 Cardiovascular Health Study (CHS) participants who were free of clinical heart failure and had Year 2-baseline 2D speckle tracking echocardiography and two measurements of estimated glomerular filtration rate (eGFR) (Year 2 and Year 9). "Archival" speckle tracking of digitized echocardiogram videotapes was utilized to measure left ventricular longitudinal strain (LVLS), LV early diastolic strain rate (EDSR), left atrial reservoir strain (LARS), right ventricular free wall strain (RVFWS), and mitral annular velocity (e'). Multivariable Poisson regression models that adjusted for demographics and cardiovascular risk factors were used to investigate the independent associations of cardiac mechanics indices and decline in kidney function defined as a 30% decline in eGFR over 7 years.

RESULTS: In risk factor (RF) models LVLS, EDSR, RVFWS, and e' were all significantly associated with the prevalence of kidney disease. After multivariable adjustment, left atrial dysfunction (RR 1.18 [95% CI 1.01, 1.38] per SD lower LARS] and left ventricular diastolic dysfunction (RR 1.21 [95% CI 1.04, 1.41] per SD lower EDSR) were each significantly associated with 30% decline in eGFR.

CONCLUSIONS: Subclinical myocardial dysfunction suggesting abnormal diastolic function detected by 2D speckle-tracking echocardiography was independently associated with decline in kidney function over time. Further studies are needed to understand the mechanisms of these associations and to test whether interventions that may improve subclinical myocardial dysfunction can prevent decline of kidney function.

1 aMehta, Rupal1 aBůzková, Petra1 aPatel, Harnish1 aCheng, Jeanette1 aKizer, Jorge, R1 aGottdiener, John, S1 aPsaty, Bruce1 aKhan, Sadiya, S1 aIx, Joachim, H1 aIsakova, Tamara1 aShlipak, Michael, G1 aBansal, Nisha1 aShah, Sanjiv, J uhttps://chs-nhlbi.org/node/932002865nas a2200217 4500008004100000022001400041245010500055210006900160260001600229520220200245100001902447700001602466700002002482700002002502700001902522700002002541700001702561700001602578700001702594856003602611 2024 eng d a2641-765000aAssociation of Fibroblast Growth Factor 23 and Cardiac Mechanics in the Cardiovascular Health Study.0 aAssociation of Fibroblast Growth Factor 23 and Cardiac Mechanics c2024 Nov 193 a

BACKGROUND: Elevated levels of fibroblast growth factor 23 (FGF23) are associated with left ventricular hypertrophy and heart failure (HF) in individuals with and without kidney disease. Prior studies investigated the association of FGF23 and structural cardiac changes using conventional echocardiography, which is limited in its ability to detect early cardiac dysfunction. We investigated the relationship between FGF23 levels and cardiac dynamics using two-dimensional speckle tracking echocardiography (2D-STE), a novel imaging modality.

METHODS: This was a cross-sectional analysis of data from the Cardiovascular Health Study, an ongoing prospective, population-based cohort study. The study population included 506 participants from CHS with available c-terminal (cFGF23) and intact FGF23 (iFGF23) measurements from 1996-1997 and 2D-STE images from 1994-1995. Forty two percent of the study population had CKD, defined as an eGFR < 60 ml/min/1.73m2, and the mean eGFR was 63 ml/min/1.73m2. The primary exposures were cFGF23 and iFGF23. The primary outcomes were six 2D-STE parameters performed at the 1994-1995 study visit. Linear regression models were used to examine the independent associations of FGF23 with six cardiac 2D-STE indices adjusting for demographics, cardiovascular risk factors, markers of kidney disease severity, and inflammation.

RESULTS: cFGF23 levels were moderately correlated with iFGF23 levels in the CHS population. In fully adjusted models, cFGF23 was associated with left atrial dysfunction, but no other cardiac imaging parameter (β estimate -2.47; 95% Confidence Interval -4.68, -0.25; Table 2 ). iFGF23 was not associated with any of the six 2D-STE indices. Limitations include small sample size and noncurrent FGF23 measurements and 2D-STE imaging.

CONCLUSIONS: In a limited sample of individuals enrolled in the CHS with c- and i-FGF23 measurements, we did not find consistent associations between FGF23 levels and 2D-STE parameters. Further investigations in a larger population with concurrent 2D-STE are needed to better understand the associations of FGF23 with early changes in cardiac mechanics.

1 aJain, Keertana1 aKatz, Ronit1 aIsakova, Tamara1 aKizer, Jorge, R1 aSharma, Shilpa1 aPsaty, Bruce, M1 aShah, Sanjiv1 aIx, Joachim1 aMehta, Rupal uhttps://chs-nhlbi.org/node/9853