Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio and Cardiorenal Syndrome Type 2 in the Systemic Sclerosis EUSTAR Cohort

Abstract

ObjectiveTo evaluate the association between tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio and estimated glomerular filtration rate (eGFR) and their association with mortality in European Scleroderma Trials and Research (EUSTAR) cohort.MethodsSystemic sclerosis (SSc) patients from EUSTAR database with TAPSE, sPAP and parameters required to calculate eGFR were included. Logistic regression and Cox regression analysis were performed to evaluate TAPSE/sPAP as a risk factor for chronic kidney disease (CKD) and overall survival.Results2370 SSc patients were included. 284 (12%) patients had CKD stage 3a‐5. TAPSE/sPAP [OR 0.479 (95% CI 0.310–0.743), p < 0.001], arterial hypertension [OR 3.118 (95% CI 2.173–4.475), p < 0.001], diastolic dysfunction [OR 1.670 (95% CI 1.148–2.428), p < 0.01] and NT‐proBNP [OR 1.165 (95% CI 1.041–1.304), p < 0.01] were associated with CKD stage 3a‐5. TAPSE/sPAP ≤ 0.32 mm/mmHg [HR 3.589 (2.236–5.761), p < 0.001], eGFR < 60 mL/min/1.73m2 [HR 2.818 (1.777–4.468), p < 0.001] and age [HR 1.782 (1.348–2.356), p < 0.001] were the most significant predictive factors for all‐cause mortality. 276 SSc patients had pulmonary hypertension (PH) confirmed by RHC with 69 (25%) having CKD stage 3a‐5. No difference was found in eGFR between PH patients with reduced or normal cardiac index (CI).ConclusionReduced TAPSE/sPAP ratio is independently associated with CKD. TAPSE/sPAP ratio ≤ 0.32 mm/mmHg and eGFR < 60 mL/min/1.73m2 are prognostic factors for all‐cause mortality. In SSc patients with PH, eGFR is independent by reduced cardiac output.This article is protected by copyright. All rights reserved.