A decline in renal function is associated with a reduction in myocardial mechano-energetic efficiency in individuals at high cardiometabolic risk.

BACKGROUND

Heart failure and chronic kidney disease are closely interrelated conditions with rising global prevalence and incidence. Depressed myocardial mechano-energetic efficiency (MEE), reflecting the left ventricle's capacity to convert chemical energy from oxidative metabolism into mechanical work, is recognized as an early marker of systolic dysfunction. This cross-sectional study aimed to investigate the relationship between estimated glomerular filtration rate (eGFR) and myocardial MEE in individuals at high cardiometabolic risk.

METHODS

Myocardial MEE per gram of left ventricular mass (MEEi) (mL/sec*g-1) was assessed via echocardiography in 3,572 adults participating in the CATAnzaro MEtabolic RIsk factors study. Participants were stratified into four categories based on eGFR (G1-G4), in accordance with the Kidney Disease: Improving Global Outcomes classification.

RESULTS

Individuals with mildly to severely reduced eGFR (G2, G3 and G4 categories) exhibited a significant reduction in myocardial MEEi compared to the G1 group. In multivariate linear regression analyses, declining eGFR remained significantly associated with reduced MEEi, even after adjusting for a broad range of cardiometabolic confounders, including age, sex, BMI, lipid profile, glucose tolerance status, hsCRP, HOMA-IR index, and the use of glucose-lowering, antihypertensive, and lipid-lowering medications.

CONCLUSIONS

Our findings demonstrate that a consistent reduction in renal function across eGFR categories is independently associated with reduced myocardial MEEi in individuals with high cardiometabolic risk suggesting that even a mild decline in nearly normal renal function may contribute to altered myocardial energetics.