Abnormal Right Ventricular to Pulmonary Artery Coupling in Patients with End-Stage Kidney Disease and Normalization After Renal Transplantation: A Observational Study

Abstract

Introduction: Pulmonary hypertension and right ventricular (RV) dysfunction are associated with an increase in mortality and worse prognosis in patients with end-stage kidney disease (ESKD), but pathophysiologic mechanisms underlying the progression of RV dysfunction remain incompletely understood. The present study aimed to understand right ventricular to pulmonary artery (RV-PA) coupling, which is an early indicator of transition to RV dysfunction, to better characterize adaptive RV response to increased afterload in ESKD patients and changes in RV-PA coupling following renal transplantation. Methods: One hundred eleven patients with ESKD, including 49 patients scheduled for renal transplantation, underwent a detailed echocardiographic examination and measurement of tricuspid annular plane excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio, and a repeat examination was performed 6 months after the baseline examination. Results: Patients with ESKD had significantly lower TAPSE/PASP ratio at baseline (1.02 [0.71-1.63] vs. 1.29 [1.09-1.96], p < 0.001). In 40 patients that underwent transplantation, TAPSE/PASP ratio increased significantly from (0.97 [0.72-1.42] to 1.30 [1.01-1.82], p = 0.03), while in 27 patients remained on dialysis, there was a nonsignificant reduction in TAPSE/PASP ratio (1.21 [0.71-1.62] vs. 0.84 [0.61-1.38], p = 0.44). The change in TAPSE/PASP ratio correlated significantly with the change in pulmonary vascular resistance (OR: 0.61, 95% CI: 0.51-0.72, p < 0.001) and left ventricular mass index (OR: 0.97, 95% CI: 0.96-0.99, p = 0.001) after adjustment. Conclusions: Patients with ESKD had abnormal RV-PA coupling, as indicated by a reduced TAPSE/PASP ratio, which normalizes 6 months after renal transplantation.