Peak Tricuspid Regurgitation Jet Velocity and Kidney Outcomes in Patients With Heart Failure With Preserved Ejection Fraction

Introduction: 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).

Methods: This post hoc 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.

Results: 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 m², 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 m²). 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).

Conclusions: Higher pTRV was associated with lower eGFR at baseline, and higher risk of ≥30% eGFR decline and creatinine doubling among patients with HFpEF.