Do not underestimate the blood urea nitrogen-to-creatinine ratio in heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The blood urea nitrogen-to-creatinine ratio (BUN/SCr) has been proposed as a prognostic marker in heart failure (HF). We aimed to evaluate whether BUN/SCr predicts mortality outcomes in a real-world Southern European population with decompensated chronic HF. Methods We retrospectively studied 1057 patients with chronic HF admitted to our emergency department between November 2016 and December 2017 with acute decompensation. We excluded patients with a GFR <15mL/min/m2 or on dialysis. The incidence of cardiovascular (CV) and all-cause death was evaluated through multivariable logistic regression models and by Kaplan-Meyer survival curves. Results 1025 patients were included, median age 80 years (IQR 73-85), 52.4% male, mean LVEF 42.8 ± 12.7%, and mean GFR 57.2 ± 23.9 mL/min/m2. Mean BUN/SCr was 24.9 ± 8.2 and mean SBP was 139 ± 29mmHg (r=-0.17, p < 0.001). After a median follow-up of 5 months (IQR 3-11 months), CV and all-cause death occurred in 8.0% and 21.6%, respectively. Mean BUN/SCr was higher in patients with fatal outcomes both for CV (31.3 vs. 24.3, p < 0.001) and all-cause death (28.6 vs. 23.8, p < 0.001). BUN/Scr was grouped by terciles: T1 (<20.78), T2 (20.78-27.15), T3 (>27.15). In the T3 group, the multivariable-adjusted OR for CV and all-cause death was 5.43 (95% CI 2.20-13.37) and 2.72 (95% CI 1.66-4.46), respectively, compared to the T1 group. No significant differences between T1 and T2 groups. Conclusions BUN/SCr at admission predicts CV and all-cause death in patients with chronic HF after an episode of decompensation. BUN/SCr, as an easy-to-use tool, helps to identify those patients who benefit from tight monitoring both during hospitalization and after discharge. Abstract Figure_1

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Abstract 12975: Cardiac I-123 Metaiodobenzylguanidine Imaging Predicts the Risk of Cardiac Death in Patients With Chronic Heart Failure, Irrespective of Blood Urea Nitrogen to Creatinine Ratio: A Long-Term Follow Up Study

Circulation ◽

10.1161/circ.132.suppl_3.12975 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Hideyuki Hakui ◽

Takahisa Yamada ◽

Takashi Motrita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Blood Urea Nitrogen ◽

Cardiac Death ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Mibg Imaging ◽

Creatinine Ratio ◽

Urea Nitrogen

Background: Cardiac I-123 metaiodobenzylguanidine (MIBG) imaging, which reflects cardiac sympathetic activity, provides prognostic information in patients with chronic heart failure (CHF). On the other hand, elevated blood urea nitrogen to creatinine ratio (BUN/Cr), a surrogate for renal neurohumoral activation, is associated with poor outcome in patients with heart failure. However, there is no information available on the prognostic value of cardiac MIBG imaging in patients with CHF, relating to BUN/Cr. Methods: We studied 109 CHF outpatients (NYHA class:2.1±0.6, ischemic origin:52%) with left ventricular ejection fraction <40% (30±8%) in our prospective cohort study. At the enrollment, we measured serum level of BUN and Cr, and performed cardiac MIBG scintigraphy. Elevated BUN/Cr was defined as >20. The cardiac MIBG washout rate (WR) was calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. Abnormal WR was defined as >27%. Results: Forty patients had elevated BUN/Cr, and 55 patients had abnormal WR. During a follow up period of 7.5±4.2 yrs, 36 of 109 patients had cardiac death. At multivariate Cox analysis, WR was significantly independently associated with cardiac death in group with both elevated BUN/Cr (p=0.02) and normal BUN/Cr (p=0.004). Kaplan-Meier analysis showed that patients with abnormal WR had a higher risk of cardiac death than those with normal WR, in group with both elevated BUN/Cr (48%[11/23] vs 6%[1/17], p=0.02, adjusted hazard ratio 11.8[95%CI 1.5-92.2]) and normal BUN/Cr (55%[18/33] vs 17%[6/36], p=0.001, adjusted hazard ratio 4.6[95%CI 1.8-11.6]). Conclusion: The cardiac MIBG imaging could predict the risk of cardiac death in CHF, irrespective of BUN/Cr.

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