Kidney Week

Abstract: TH-PO199

Association of Tricuspid Regurgitant Jet Velocity with Kidney Function in Patients with Heart Failure with Preserved Ejection Fraction in TOPCAT

Session Information

• Hypertension and CVD: Clinical - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Oka, Tatsufumi, Tufts Medical Center, Boston, Massachusetts, United States

Tatsufumi Oka,

• Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States

Hocine Tighiouart,

• McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States

Wendy I. McCallum,

• Tuttle, Marcelle, Tufts Medical Center, Boston, Massachusetts, United States

Marcelle Tuttle,

• Testani, Jeffrey M., Yale School of Medicine, New Haven, Connecticut, United States

Jeffrey M. Testani,

• Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States

Mark J. Sarnak,

Background

Pulmonary hypertension is common and associated with higher mortality in heart failure with preserved ejection fraction (HFpEF). While increasing evidence suggests that venous congestion can cause worsening kidney function, the association of pulmonary artery systolic pressure (PASP) with kidney function remains uncertain in patients with HFpEF.

Methods

This post-hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial analyzed patients with HFpEF who had an echocardiogram at baseline. The exposure variable was tricuspid regurgitant jet velocity (TRV), a surrogate of PASP. In a cross-sectional analysis, the association of TRV with eGFR at baseline was assessed using linear regression. In a longitudinal analysis, the association of quartiles of TRV with time to eGFR decline of ≥30% was assessed using a Cox proportional hazards regression. Covariates, including patient demographics, comorbidities, laboratory data, medications, and randomized group, were adjusted in the multivariable models.

Results

Among 450 patients, median age, TRV, and eGFR at baseline were 73 years, 2.7 m/s, and 61 mL/min/1.73 m², respectively. In a multivariable analysis, each 1.0 m/s higher TRV was significantly associated with a 3.9 (95% confidence interval, 0.2–7.6) ml/min/1.73 m² lower eGFR at baseline. Over a median follow-up of 94 weeks, 52 patients died and 203 had an eGFR decline of ≥30%. Patients with a higher quartile of TRV had a higher risk of eGFR decline of ≥30% (Figure). There was no interaction by randomized group (P_interaction =0.45). An analysis using all-cause death as a competing event did not substantially change the results.

Conclusion

A higher TRV was associated with a higher risk of kidney function decline among patients with HFpEF in TOPCAT.