Left ventricular and renal dysfunction: an exploration of the cardiorenal axis

Abstract

Both left ventricular dysfunction, and renal dysfunction are world wide public health problems. In the western countries there is a rising incidence and prevalence of both conditions, with poor outcomes and high cost. These two conditions do often co-exist and the concomitant presence of both conditions accumulates risk for morbidity and mortality. In severe chronic heart failure (CHF), impaired renal function is often present, and is even a stronger risk marker than functional cardiac parameters, such as left ventricular ejection fraction or NYHA class.1 On the other hand, left ventricular dysfunction is likely to develop in patients with chronic renal dysfunction (CRD) and accumulates with worsening renal function.2 One of the first signs of left ventricular dysfunction in patients with CRD is left ventricular hypertrophy (LVH). Several studies have demonstrated an association between renal dysfunction and LVH and the prevalence of LVH increases with worsening of renal function.3 Finally, several prevalence and longitudinal studies have shown that the well known age associated decline in renal function is more pronounced in patients with coexisting cardiovascular risk factors and pre-existing atherosclerotic vascular disease, suggesting that this decline is not a consistent phenomenon and reflect cardiovascular co-morbidity rather than normal aging