In heart failure, echocardiographic parameters of right ventricular function are powerful tools to predict renal failure

Abstract

Background: Chronic kidney disease (CKD) has a high prevalence in patients with heart failure (HF) and is associated with prolonged hospitalization, increased need for intensive care and mortality. There is an urgent need to identify factors that influence the interaction between heart and kidney disorders, often described as cardiorenal syndrome (CRS). We investigated the epidemiology and risk factors of renal insufficiency in patients with HF.

Methods: We conducted a retrospective cohort study including 281 consecutive patients with HF that are examined at regular intervals at our outpatient clinic for HF. CKD was defined as the presence of an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² and worsening renal function (WRF) was defined as a decrease of eGFR > 15% within a year. We assessed the patient's medical history, laboratory and echocardiographic parameters at baseline and after 12 months.

Results: Right ventricular dysfunction was associated with CKD and WRF. In particular, echocardiographic parameters 'tricuspid annular plane systolic excursion (TAPSE) < 15 mm' (P < 0.001; OR 2.932), 'tricuspid regurgitation (TR) > I°' [P < 0.001; odds ratio (OR) 5.958] and dilatation of inferior vena cava (IVC) (P < 0.001; OR 3.670) were significantly correlated with renal failure. N-terminal pro-B-type natriuretic peptide levels were significantly associated with CKD (P < 0.001; OR 6.109) and correlated with pressure and volume load of the right heart.

Conclusions: The results of this work support the theory of right-sided cardiac backward failure, often accompanied by hypervolaemia, as a leading cause of HF-related renal failure. Right heart parameters, especially TR, TAPSE and IVC, are obtained easily by transthoracic echocardiography and can predict renal failure.

Keywords: TAPSE; chronic kidney disease; heart failure; inferior vena cava; right ventricular dysfunction; tricuspid regurgitation.

Figure 1

CKD percentage in patients with HFpEF, HFmrEF and HFrEF. Of the patients with HFrEF, 66.9% suffered from CKD. The percentage in HFmrEF and HFpEF group was lower (18.6% and 14.5%). CKD, chronic kidney disease; HFmrEF, heart failure with mid‐range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.

Figure 2

Linear regression analysis for eGFR dependent on LVEF (regression coefficient B (±standard error) 0.591 (±0.110); 95% CI [0.375; 0.806], P < 0.001). eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction.

Figure 3

(A) Box plot analysis of eGFR in patients with and without dilatation of the IVC. Mean eGFR was lower in patients with dilatation of the IVC [49.1 ± 24.2 mL/min/1.73 m² vs. 63.1 ± 23.6 mL/min/1.73 m² in patients without dilatation of the IVC (P < 0.001)]. (B) Box plot analysis of eGFR in patients with estimated RAP < 15 mmHg and RAP ≥ 15 mmHg. Mean eGFR was lower in patients with estimated RAP ≥ 15 mmHg [52.0 ± 25.3 mL/min/1.73 m² vs. 64.07 ± 23.0 mL/min/1.73 m², in patients with RAP < 15 mmHg (P < 0.001)]. eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction.

Figure 4

Linear regression analysis for eGFR dependent on sPAP (regression coefficient B (±standard error) −0.284 (±0.092), 95% CI [−0.465; −0.102]; R ² = 0.033; P = 0.002). CI, confidence interval; eGFR, estimated glomerular filtration rate; TAPSE, tricuspid annular plane systolic excursion.

Figure 5

Linear regression analysis for eGFR dependent on TAPSE [regression coefficient B (±standard error) 2.508 (±0.351); 95% CI (1.821; 3.207); R ² = 0.160; P < 0.001]. CI, confidence interval; eGFR, estimated glomerular filtration rate; sPAP, systolic pulmonary artery pressure.