The Relevance Of Tricuspid Annular Plane Systolic Excursion And Glomerular Filtration Rate In Patients With Acute Decompensated Heart Failure

BackgroundsAs is severe various stage of the development of all heart disease, heart failure(heart failure, HF) has became to this century’s most important cardiovascular disease. It is a clinical syndrome with molecular abnormality which is caused by multiple heart diseases that can result in abnormality of the heart structure and function, injury ventricular filling and/or pump function, decrease cardiac output and increase venous pressure.Acute decompensated heart failure(ADHF) is a progressive phase of heart failure and is the most common type of heart failure patients admitted to hospital.It is caused by acute damaging of the cardiomyocyte or suddenly increased of cardiac loading, leads to deterioration of normal or still be in compensative condition of heart function and makes the condition of chronic heart failure patients become worse, the heart function worsen to decompensated dramatically which leads to dyspnea, edema and other typical clinical manifestations of the syndrome.Clinical studies have shown that approximately 30-50% ADHF patients will have acute renal insufficiency during hospitalization, which is so called acute cardio-renal syndrome(CRS). It always refers to the complex interaction between theheart and kidneys, creating a vicious cycle when one organ can not be compensate to another organ’s damage, it will result in two organ common been damaged.Once the CRS occurs,often makes the treatment of patients with acute decompensated heart failure complicates,increases the duration of hospital days and mortality.The pathophysiology of CRS is extremely complex, the treatment is much more difficult and represents poor prognosis. Therefore, we should assess the renal function in patients with ADHF as soon as possible and identify who is the high-risk CRS patients.Of the most important is the renal function should be early predicted and diagnosis, and be handled at the same time which is the key to improve the prognosis.But so far there are no accurate and useful prediction methods. In the past,the traditional theories have pointed out that a decrease in arterial perfusion pressure and renal blood flow(RBF) are the main cause of renal dysfunction in patients with impaired cardiac output due to pump failure,so-called “forward heart failue”.But this can not fully explain all the pathophysiology of patients with CRS.At the same time some studies have confirmed an important relationship between renal dysfunction and venous congestion, so-called “afterward heart failure” which is left heart failure further influence to the right heart dysfunction leading to venous return decreased so that abdominal and renal venous pressure increased, renal perfusion reduced.This shows that right ventricular dysfunction may be the connection between ADHF patients with impaired renal function.There are many ways to assess right ventricular function, including hemodynamic, ultrasonics and imaging methods. Tricuspid annular plane systolic excursion(TAPSE)is measured by M-mode ultrasound, which is in the four-chamber view measured tricuspid annular along the longitudinal direction of the right ventricular ‘s systolic excursion.The right ventricular ejection fraction and right ventricular fractionalarea change were positively correlated with it and may reflect right ventricular muscle fibers contraction in the axial direction. Numerous studies confirm TAPSE and right ventricular function has a good correlation.It is recommended as a conventional measure tool by the American Association of ultrasound evaluation of right ventricular function.But whether TASPE in patients with ADHF has relation CRS or can be used as predictor have not been reported.ObjectiveThis research use tricuspid annular plane systolic excursion(TAPSE) as a reflection of the right ventricular systolic function indicator, to explore the association between TAPSE and renal function in the patients with acute decompensated heart failure(ADHF).Also,screen the early clinical predictors of cardiorenal syndrome.MethodSelect 102 cases of acute decomsated heart failure patients by the selection of echocardiographic evidence of left ventricular ejection fraction(LVEF) ≤50%admitted from May 2014 to July 2015 in the First Affiliated Hospital of Zhengzhou University, Department of Cardiology. All patients admitted to hospital within 6hours condect venous blood test to determine laboratory and physical examination results such as NT-proBNP, electrolytes, BUN, creatinine.Transthoracic echocardiography was performed to measure tricuspid annular plane systolic excursion tricuspid(TAPSE), left ventricular ejection fraction(LVEF), pulmonary artery systolic pressure( PASP), left ventricular end diastolic diameter(LVDd), right ventricular end diastolic diameter(RVDd). Mean arterial pressure(MAP) is measured by Korotkoff auscultation method. The eGFR was measured by the simplified Modification of Diet in Renal Disease(MDRD) formula. MDRD equation glomerular filtration rate(eGFR), and eGFR <60 ml / min / 1.73 m2 is defined as renal dysfunction.According to whether the eGFR is less than 60 ml / min / 1.73 m2,patients were divided into two groups:normal renal function grop(eGFR ≥60 ml /min / 1.73 m2, n = 54), and renal dysfunction group(eGFR <60 ml / min / 1.73 m2, n= 48). correlation analysis. All the blood indexes and ultrasound echocardiographic indicators were analyzed between the two group above and compared respectively.Then analyze the relevance between TASPE and echocardiographic parameters,serum indexes in renal dysfunction grope.Result1. In addition to the NYHA functional class, age, gender, heart rate, MAP and use of drugs between renal dysfunction group and normal renal function grop were no significant difference2. The levels of serum sodium, serum potassium, BUN, Cr and NT-proBNP had no significant difference.3.The TAPSE of renal dysfunction group [(16.4 ± 4.0) mm ]was significantly lower than normal renal function group [(18.9 ± 3.8) mm], and the difference was statistically significant(P <0.05); between the two groups LVDd, RVDd,PASP and LVEF were not statistically significant(P> 0.05).4. The eGFR of the renal dysfunction group showed that TAPSE was significantly positive correlated(r = 0.62, P <0.05), but other indicators such as NT-proBNP, PASP, LVEF,MAP had no correlation.Conclusion1. Acute decompensated heart failure patients have a high incidence of renal dysfunction.2.Acute decompensated heart failure patients with right ventricular dysfunction have a higher incidence of renal dysfunction.3. Acute decompensated heart failure patients with TAPSE deterioration is strongly associated with of renal dysfunction, and could be early clinical predictor of the cardiorenal syndrome.