In heart failure, echocardiographic parameters of right ventricular function are powerful tools to predict renal failure

Selected in ESC Heart Failure by Izabella Uchmanowicz

Why this study – the rationale/objective?

In heart failure, echocardiographic parameters of right ventricular function are powerful tools to predict renal failure.  This publication addresses an important clinical issue: the prediction of chronic kidney disease (CKD) in patients suffering from heart failure (HF). Chronic kidney disease significantly worsens the prognosis in HF patients, highlighting the clinical importance of early identification and management. This study specifically evaluates echocardiographic parameters of right ventricular function as potential predictors for renal impairment, aiming to refine diagnostic strategies and improve clinical outcomes.

How was it executed – the methodology?

The authors conducted a retrospective cohort study involving 281 consecutive HF patients from a specialized outpatient clinic. Patients were evaluated for renal function (using estimated glomerular filtration rate, eGFR) and underwent echocardiographic assessments at baseline and after 12 months. Key right ventricular parameters measured included tricuspid annular plane systolic excursion (TAPSE), degree of tricuspid regurgitation (TR), and dilatation of the inferior vena cava (IVC). Logistic regression analyses were performed to identify significant predictors of CKD and worsening renal function (WRF).

What is the main result?

The study found significant associations between right ventricular dysfunction and CKD or WRF in HF patients. Notably, parameters such as TAPSE <15 mm, TR > I°, and IVC dilatation strongly predicted renal impairment. Among these, TR showed the highest odds ratio for CKD (OR: 5.958), closely followed by elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (OR: 6.109), reflecting volume overload and increased cardiac pressure.

Critical reading and the relevance for clinical practice

The critical finding of this study is the robust predictive value of simple echocardiographic parameters of right ventricular dysfunction, such as TAPSE, TR, and IVC dilatation, in identifying patients at increased risk for renal failure. The strength of this approach lies in its practicality; these parameters are readily assessable via routine transthoracic echocardiography, making them highly accessible tools for widespread clinical application.

The implications for clinical practice are significant. By incorporating these parameters into routine evaluations, clinicians can proactively manage patients at higher risk for developing CKD, potentially improving outcomes through early intervention. Moreover, this study supports the pathophysiological concept of right-sided backward failure contributing to renal dysfunction through venous congestion, rather than purely forward flow limitations.

However, the retrospective nature of the study warrants cautious interpretation, as it may limit the control over data quality and introduces potential selection bias. The study cohort, though reflective of typical clinical populations, was heterogeneous, possibly affecting the statistical robustness due to confounding factors and collinearity among predictors.

Further prospective, randomized studies are essential to confirm these findings and to explore whether therapeutic interventions targeting right ventricular function and reducing congestion might effectively mitigate renal dysfunction in HF patients.

In summary, this study underscores the clinical utility and importance of routine echocardiographic evaluation of right ventricular parameters in predicting renal dysfunction, potentially guiding clinicians toward more personalized and proactive management strategies in heart failure care.