title: Right ventricular dysfunction is associated with chronic kidney disease and predicts survival in patients with chronic systolic heart failure.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) and right ventricular (RV) dysfunction are important predictors of prognosis in heart failure (HF). We investigated the relationship between RV dysfunction and CKD in outpatients with chronic systolic HF, an association which remains poorly defined.
  
  
  RESULTS
  Outpatients (n = 373) with chronic HF and left ventricular ejection fraction (LVEF) ≤45% underwent clinical and echo-Doppler evaluations and were followed up for 31 ± 24 months. Tricuspid annular plane systolic excursion (TAPSE) assessed RV dysfunction. The estimated glomerular filtration rate (GFR) was measured by the simplified Modification of Diet in Renal Disease (MDRD) formula. Correlation analysis was used to characterize the association between TAPSE and estimated GFR. Odds ratios (ORs) for CKD and hazard ratios (HRs) for all-cause mortality were assessed using multivariable logistic or proportional hazards regression models. TAPSE and estimated GFR were significantly correlated (r = 0.38, P < 0.0001). TAPSE ≤14 mm was associated with elevated estimated right atrial pressure and N-terminal pro brain natriuretic peptide levels. TAPSE ≤14 mm increased the odds of estimated GFR <60 mL/min/1.73 m(2), OR [95% confidence interval (CI)] = 2.51(1.44-4.39), P < 0.0001 and predicted all-cause mortality, HR (95% CI) = 1.80 (1.20-2.71) after multivariable adjustment.
  
  
  CONCLUSIONS
  Right ventricular dysfunction is cross-sectionally associated with CKD and prospectively predicts survival in outpatients with chronic systolic HF. These data suggest RV dysfunction to be one of the possible mechanistic links between HF and CKD.
authors.affiliation: Cardiac, Thoracic and Vascular Department, University of Pisa, Via Paradisa 2, Pisa, Italy. f.dini@ao-pisa.toscana.it
authors.forename: Frank L
authors.initials: FL
authors.lastname: Dini
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Demmer
authors.forename: Anca
authors.initials: A
authors.lastname: Simioniuc
authors.forename: Doralisa
authors.initials: D
authors.lastname: Morrone
authors.forename: Francesca
authors.initials: F
authors.lastname: Donati
authors.forename: Giacinta
authors.initials: G
authors.lastname: Guarini
authors.forename: Enrico
authors.initials: E
authors.lastname: Orsini
authors.forename: Paolo
authors.initials: P
authors.lastname: Caravelli
authors.forename: Mario
authors.initials: M
authors.lastname: Marzilli
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016001:Confidence Intervals; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010045:Outpatients; D011379:Prognosis; D012307:Risk Factors; D013223:Statistics as Topic; D013318:Stroke Volume; D014481:United States; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D016277:Ventricular Function, Left