Publication

Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure

Journal Paper/Review - Dec 1, 2008

Units
PubMed
Doi

Citation
Maeder M, Holst D, Kaye D. Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure. Journal of cardiac failure 2008; 14:824-30.
Type
Journal Paper/Review (English)
Journal
Journal of cardiac failure 2008; 14
Publication Date
Dec 1, 2008
Issn Electronic
1532-8414
Pages
824-30
Brief description/objective

BACKGROUND: In heart failure (HF), renal dysfunction is associated with an adverse prognosis. Impaired renal perfusion from left ventricular dysfunction is thought to be a principal underlying mechanism. Less is known about the influence of venous congestion, including the potential contribution of tricuspid regurgitation (TR). METHODS AND RESULTS: Echocardiograms and a simultaneous (+/-1 day) blood sample from 196 HF patients were analyzed. Patients with at least moderate TR (n = 78) had larger right-sided cardiac cavities, higher right ventricular systolic pressure, lower estimated glomerular filtration rate (eGFR), higher serum urea nitrogen (SUN), and SUN/creatinine ratio than patients with less than moderate TR (n = 118). In multivariate linear regression analysis, TR severity (P = .003), older age (P < .001), and loop diuretic use (P = .008) were independently associated with lower eGFR, and use of inhibitors of the renin-angiotensin-aldosterone system was associated with higher eGFR (P = .001). TR severity (P < .001) and older age (P < .001) were independently associated with higher SUN. TR severity (P = .004) and smaller left ventricular end-diastolic diameter (P = .048) were independent predictors of a higher SUN/creatinine ratio (P = .004). CONCLUSIONS: Although a causal relationship cannot be proven, we suggest that significant TR contributes to renal dysfunction in HF patients, probably by elevation of central and renal venous pressure.