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Peak exercise oxygen uptake and changes in renal function in patients after acute myocardial infarction

Published:October 29, 2022DOI:https://doi.org/10.1016/j.hrtlng.2022.10.013

      Highlights

      • Ischemic heart events such as AMI cause a decline in renal function.
      • This study examined the effect of peak VO2 on changes in renal function after AMI.
      • The slope of eGFR decline was greater with lower peak VO2 levels.
      • Lower peak VO2 levels associated with higher odds ratio for rapid decline in eGFR.

      Abstract

      Background

      The impact of exercise tolerance on renal function change after acute myocardial infarction (AMI) is not clear.

      Objectives

      The present study aimed to elucidate the effect of peak exercise oxygen uptake (VO2) levels on longitudinal changes in renal function up to 1 year after onset of AMI.

      Methods

      This retrospective longitudinal study enrolled 198 AMI patients. Symptom-limited cardiopulmonary exercise testing was performed at completion of early Phase II cardiac rehabilitation, and peak VO2 levels were defined as the primary exposure factor. The estimated glomerular filtration rates (eGFRs) at baseline, 3 months, 6 months and 1 year were collected. Generalized estimating equation (GEE) models were used to test the longitudinal effect of peak VO2 levels on within-patient changes in eGFR.

      Results

      Patients were stratified into tertile groups (Low group, 12.3 ± 1.3 mL/kg/min; Mid group, 15.3 ± 0.7 mL/kg/min; and High group, 19.1 ± 2.3 mL/kg/min) according to peak VO2 levels. The slopes of eGFR over 1 year in the Low (p = 0.024) and Mid groups (p = 0.037) were lower compared to the High group. The Low group had a significantly higher odds ratio of experiencing rapid renal function decline than the High group (odds ratio, 2.87; p = 0.012).

      Conclusions

      There was a significant effect of lower peak VO2 on rapid decline in renal function after AMI. Our findings suggest that the coexistence of exercise intolerance may be a novel risk factor for rapid decline in renal function after AMI.

      Graphical abstract

      Keywords

      Abbreviations:

      ACEI (angiotensin-converting enzyme inhibitors), AMI (acute myocardial infarction), ARB (angiotensin receptor blockers), BNP (B-type natriuretic peptide), CKD (chronic kidney disease), CPET (cardiopulmonary exercise testing), eGFR (estimated glomerular filtration rate), GEE (generalized estimating equation), LVEF (left ventricular ejection fraction), PCI (percutaneous coronary intervention), VO2 (exercise oxygen uptake)
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