Edmonston Daniel L, Rajagopal Sudarshan, Wolf Myles
Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Kidney Int Rep. 2020 Oct 3;5(12):2275-2283. doi: 10.1016/j.ekir.2020.09.033. eCollection 2020 Dec.
Pulmonary hypertension (PH) is a common yet incompletely understood complication of chronic kidney disease (CKD). Although transthoracic echocardiogram is commonly used to noninvasively estimate PH, it has not been validated in a CKD population. We investigated the utility of this diagnostic tool for CKD-associated PH in a large right heart catheterization (RHC) cohort.
We reviewed RHC and echocardiography data in 4036 patients (1714 with CKD) obtained between 2011 and 2014 at a single center. We used multivariate regression to determine the associations of echocardiography measurements with PH, and evaluated whether estimated glomerular filtration rate (eGFR) modified these associations. Using internal validation, we sequentially added measurements to predictive models and analyzed the incremental predictive performance using the change in the area under the receiver operating characteristic curve (ΔAUC) and net reclassification improvement.
The echocardiography measurements most strongly associated with the diagnosis of PH included tricuspid regurgitant velocity (TRV), tricuspid annular plane systolic excursion (TAPSE), right atrial pressure, diastolic dysfunction, and right ventricular function. Among these measurements, eGFR significantly modified the associations of TAPSE and diastolic dysfunction with the diagnosis of PH. The model consisting of a combination of TRV, right atrial pressure, and TAPSE most accurately predicted the diagnosis of PH in a CKD population (AUC 0.82).
The optimal model to predict PH diagnosis included TRV, right atrial pressure, and TAPSE. Since TAPSE more strongly associated with PH in the CKD population, these findings support a CKD-specific approach to the development of noninvasive screening algorithms for PH.
肺动脉高压（PH）是慢性肾脏病（CKD）常见但尚未完全了解的并发症。虽然经胸超声心动图常用于无创评估PH，但尚未在CKD人群中得到验证。我们在一个大型右心导管插入术（RHC）队列中研究了这种诊断工具对CKD相关PH的效用。
我们回顾了2011年至2014年在单一中心获得的4036例患者（1714例患有CKD）的RHC和超声心动图数据。我们使用多变量回归来确定超声心动图测量值与PH的关联，并评估估计肾小球滤过率（eGFR）是否改变了这些关联。通过内部验证，我们将测量值依次添加到预测模型中，并使用受试者工作特征曲线下面积的变化（ΔAUC）和净重新分类改善来分析增量预测性能。
与PH诊断最密切相关的超声心动图测量值包括三尖瓣反流速度（TRV）、三尖瓣环平面收缩期位移（TAPSE）、右心房压力、舒张功能障碍和右心室功能。在这些测量值中，eGFR显著改变了TAPSE和舒张功能障碍与PH诊断的关联。由TRV、右心房压力和TAPSE组合而成的模型最准确地预测了CKD人群中的PH诊断（AUC 0.82）。
预测PH诊断的最佳模型包括TRV、右心房压力和TAPSE。由于TAPSE在CKD人群中与PH的关联更强，这些发现支持采用CKD特异性方法来开发PH的无创筛查算法。
