Tricuspid regurgitation pressure gradient identifies prognostically relevant worsening renal function in acute heart failure. (11th March 2020)

• Record Type: Journal Article
• Authors: Hayasaka, Kazuto; Matsue, Yuya; Kitai, Takeshi; Okumura, Takahiro; Kida, Keisuke; Oishi, Shogo; Akiyama, Eiichi; Suzuki, Satoshi; Yamamoto, Masayoshi; Mizukami, Akira; Yoshioka, Kenji; Kuroda, Shunsuke; Kagiyama, Nobuyuki; Yamaguchi, Tetsuo; Sasano, Tetsuo
• Is Part Of: European heart journal. Volume 22:Number 2(2021)
• Page Start: 203
• Page End: 209
• Publication Date: 2020-03-11
• Subjects: acute heart failure -- worsening renal function -- tricuspid regurgitation pressure gradient; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa035
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims: Not all worsening renal function (WRF) during heart failure treatment is associated with a poor prognosis. However, a metric capable providing a prognosis of relevant WRF has not been developed. Our aim was to evaluate if a change in tricuspid regurgitation pressure gradient (TRPG) could discriminate prognostically relevant and not relevant WRF in patients with acute heart failure (AHF). Methods and results: We examined 809 consecutive hospitalized patients with heart failure (78 ± 12 years, 54% male). WRF was defined as an increase in creatinine >0.3 mg and ≥25% from admission to discharge. TRPG was measured at admission and before discharge using echocardiography. The primary outcome was all-cause death within 1-year after discharge. Patients were classified as follows for analysis: no WRF and no TRPG increase ( n = 523); no WRF and TRPG increase (no WRF with iTRPG, n = 170); WRF and no TRPG increase (WRF without iTRPG, n = 90); and WRF and TRPG increase (WRF with iTRPG, n = 26). A change in TRPG weakly but significantly correlated to a change in haemoglobin and haematocrit, a percent decrease in brain natriuretic peptide, and body weight reduction during the index period of hospitalization. All-cause mortality within 1 year was higher in patients with WRF and iTRPG, compared to the other three groups ( P = 0.026). On Cox regression analysis, only WRF with iTRPG was associated with higher mortality (hazard ratio 4.24, P = 0.001), even after adjustment for other confounders. Conclusion: An increase in TRPG may provide a marker to identify prognostically relevant WRF in patients with AHF.