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. 2024 Dec;46(2):2364766.
doi: 10.1080/0886022X.2024.2364766. Epub 2024 Jun 14.

Assessment of right ventricular dysfunction and its association with excess risk of cardiovascular events in patients undergoing maintenance hemodialysis

Chen Wang  1   2   3 , Li Meng  1   2   3 , Xu-Yang Cheng  1   2   3 , Yu-Qing Chen  1   2   3
Affiliations

Assessment of right ventricular dysfunction and its association with excess risk of cardiovascular events in patients undergoing maintenance hemodialysis

Chen Wang et al. Ren Fail. 2024 Dec.

Abstract

Aims: Recent accumulating evidence has recently documented a significant prevalence of right ventricular dysfunction (RVD) in end-stage renal disease (ESRD) patients. Tricuspid annular plane systolic excursion (TAPSE)/pulmonary-artery systolic pressure (PASP) ratio assessed with echocardiography might be a useful clinical index of right ventricular (RV) -pulmonary arterial (PA) coupling. The current study aimed to investigate the value of the TAPSE/PASP ratios in patients on maintenance hemodialysis (MHD).

Methods: We studied 83 times echocardiographic tests from 68 patients with MHD. The associations of TAPSE/PASP ratios with echocardiography variables, clinical characteristics, and biochemical parameters were analyzed, as well as the associations of TAPSE/PASP ratios with odds of all-cause mortality, cardiovascular disease (CVD) events and frequent intermittent dialysis hypotension (IDH).

Results: Correlation analysis showed TAPSE/PASP ratios positively correlated with LVEF and negatively correlated with E/A and E/e' values. For clinical and biochemical parameters, TAPSE/PASP ratios negatively correlated with BNP, NT-proBNP, age, CRP, and average interdialysis weight gain (ΔBW) and positively correlated with albumin. Logistic regression analysis, which induced the TAPSE/PASP ratio as a continuous variable (per 0.1 mm/mmHg increase), identified that the TAPSE/PASP ratio was associated with decreased CVD events (OR 0.386 [95% CI 0.231-0.645], p < 0.001) and frequent IDH odds (OR 0.571 [95% CI 0.397-0.820], p = 0.002). Moreover, the TAPSE/PASP ratio independently predicted CVD events (adjusted HR 0.539 [95% CI 0.391-0.743], p < 0.001) during a follow-up period of 12 months.

Conclusions: RVD, assessed by echocardiography TAPSE/PASP ratio, was found to be associated with increased risks of CVD events and frequent IDH in patients with MHD.

Keywords: Right ventricular dysfunction; cardiovascular disease; echocardiography; hemodialysis.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
TAPSE/PASP ratios positively correlated with LVEF and negatively correlated with E/a and E/e’ values.
Figure 2.
Figure 2.
Both TAPSE/PASP ratios and LVEF negatively correlated with BNP and NT-proBNP.
Figure 3.
Figure 3.
TAPSE/PASP ratios positively correlated with albumin, and negatively correlated with age, CRP and average ΔBW.
Figure 4.
Figure 4.
Kaplan–Meier Survival curves for CVD events and composite outcome including both CVD events and death based on median TAPSE/PASP value (0.65 mm/mmHg).
See this image and copyright information in PMC

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