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Echocardiography to Screen for Pulmonary Hypertension in CKD.

Publication ,  Journal Article
Edmonston, DL; Rajagopal, S; Wolf, M
Published in: Kidney Int Rep
December 2020

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

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Published In

Kidney Int Rep

DOI

EISSN

2468-0249

Publication Date

December 2020

Volume

5

Issue

12

Start / End Page

2275 / 2283

Location

United States

Related Subject Headings

  • 42 Health sciences
  • 32 Biomedical and clinical sciences
 

Citation

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Edmonston, D. L., Rajagopal, S., & Wolf, M. (2020). Echocardiography to Screen for Pulmonary Hypertension in CKD. Kidney Int Rep, 5(12), 2275–2283. https://doi.org/10.1016/j.ekir.2020.09.033
Edmonston, Daniel L., Sudarshan Rajagopal, and Myles Wolf. “Echocardiography to Screen for Pulmonary Hypertension in CKD.Kidney Int Rep 5, no. 12 (December 2020): 2275–83. https://doi.org/10.1016/j.ekir.2020.09.033.
Edmonston DL, Rajagopal S, Wolf M. Echocardiography to Screen for Pulmonary Hypertension in CKD. Kidney Int Rep. 2020 Dec;5(12):2275–83.
Edmonston, Daniel L., et al. “Echocardiography to Screen for Pulmonary Hypertension in CKD.Kidney Int Rep, vol. 5, no. 12, Dec. 2020, pp. 2275–83. Pubmed, doi:10.1016/j.ekir.2020.09.033.
Edmonston DL, Rajagopal S, Wolf M. Echocardiography to Screen for Pulmonary Hypertension in CKD. Kidney Int Rep. 2020 Dec;5(12):2275–2283.
Journal cover image

Published In

Kidney Int Rep

DOI

EISSN

2468-0249

Publication Date

December 2020

Volume

5

Issue

12

Start / End Page

2275 / 2283

Location

United States

Related Subject Headings

  • 42 Health sciences
  • 32 Biomedical and clinical sciences