Oka Tatsufumi, Tighiouart Hocine, McCallum Wendy, Tuttle Marcelle, Testani Jeffrey M, Sarnak Mark J
Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA.
Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Kidney Int Rep. 2024 Jul 17;9(10):3035-3044. doi: 10.1016/j.ekir.2024.07.009. eCollection 2024 Oct.
Although venous congestion secondary to elevated pulmonary artery pressure (PAP) has been hypothesized to worsen kidney function, the association of peak tricuspid regurgitation jet velocity (pTRV), a surrogate of PAP, with kidney outcomes remains uncertain in heart failure (HF) with preserved ejection fraction (HFpEF).
This analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial analyzed participants with a left ventricular ejection fraction (LVEF) of ≥45% who had pTRV measured by echocardiography at baseline. For the cross-sectional analysis, the association of baseline pTRV with baseline estimated glomerular filtration rate (eGFR) was assessed using linear regression. For the longitudinal analysis, the association of baseline pTRV with decline in eGFR of ≥30% and doubling of serum creatinine was assessed using Cox proportional hazards models.
Among 450 participants, the mean (SD) baseline age, LVEF, pTRV, and eGFR were 72.3 (9.6) years, 58.2% (7.4%), 2.8 (0.5) m/s, and 62.1 (18.7) ml/min per 1.73 m, respectively. Each 1 SD higher pTRV was associated with a lower baseline eGFR (coefficient, -1.79; 95% confidence interval [CI], -3.48 to -0.10 ml/min per 1.73 m). Over a median (interquartile range) follow-up of 3.0 (2.0-4.4) years, 203 (45%) patients experienced ≥30% eGFR decline, and 48 (11%) experienced creatinine doubling. Each 1 SD higher pTRV was associated with a 20% higher risk of ≥30% eGFR decline (hazard ratio [HR], 1.20; 95% CI, 1.04-1.39) and a 45% higher risk of creatinine doubling (HR, 1.45; 95% CI, 1.09-1.94).
Higher pTRV was associated with lower eGFR at baseline, and higher risk of ≥30% eGFR decline and creatinine doubling among patients with HFpEF.
尽管肺动脉压（PAP）升高继发的静脉充血被认为会使肾功能恶化，但在射血分数保留的心力衰竭（HFpEF）中，作为PAP替代指标的三尖瓣反流峰值流速（pTRV）与肾脏结局之间的关联仍不明确。
对醛固酮拮抗剂治疗保留心功能心力衰竭（TOPCAT）试验进行的这项分析纳入了左心室射血分数（LVEF）≥45%且在基线时通过超声心动图测量了pTRV的参与者。对于横断面分析，使用线性回归评估基线pTRV与基线估计肾小球滤过率（eGFR）之间的关联。对于纵向分析，使用Cox比例风险模型评估基线pTRV与eGFR下降≥30%和血清肌酐翻倍之间的关联。
在450名参与者中，平均（标准差）基线年龄、LVEF、pTRV和eGFR分别为72.3（9.6）岁、58.2%（7.4%）、2.8（0.5）m/s和62.1（18.7）ml/（min·1.73m²）。pTRV每升高1个标准差，与较低的基线eGFR相关（系数，-1.79；95%置信区间[CI]，-3.48至-0.10ml/（min·1.73m²））。在中位（四分位间距）3.0（2.0 - 4.4）年的随访中，203名（45%）患者的eGFR下降≥30%，48名（11%）患者的肌酐翻倍。pTRV每升高1个标准差，与eGFR下降≥30%的风险高20%相关（风险比[HR]，1.20；95%CI，1.04 - 1.39），与肌酐翻倍的风险高45%相关（HR，1.45；95%CI，1.09 - 1.94）。
在HFpEF患者中，较高的pTRV与基线时较低的eGFR相关，以及与eGFR下降≥30%和肌酐翻倍的较高风险相关。
