PULMONARY HYPERTENSION AND RIGHT VENTRICULAR-PULMONARY ARTERIAL COUPLING IN CHRONIC HEMODIALYSIS POPULATION

Aims:

1. To analyze the relations of PH and RV-PA coupling with arteriovenous fistula (AVF) flow and current hydration 
2. To analyze the structural heart changes associated with RV-PA uncoupling
3. To reveal the prevalence and etiology of PH in the Czech hemodialysis population

Methods:

Inclusion visits of the patients included in CZecking Heart Failure in patients with advanced Chronic Kidney Disease study were analyzed. We performed expert echocardiography with non-invasive hemodynamic assessment, evaluation of AVF flow, bio-impedance analysis (BIA) and basic laboratory tests. The presence of PH was defined by the estimated pulmonary arterial systolic pressure >35 mmHg or by indirect signs of PH. RV-PA coupling was calculated as TAPSE/PASP, with values

Results: 

Data of 336 patients were analyzed. PH was present in 34 % of patients, RV-PA uncoupling was present in 25 % of patients with PH and in 2 % of those without PH. PH and RV-PA uncoupling were related to higher hydration status. The association of AVF flow and the diagnosis of PH was weak (OR 1.27, CI 1.10-1.46), and RV-PA coupling was not dependent on AVF flow. Patients with RV-PA uncoupling  had worse function and greater dilation of both ventricles compared to those with RV-PA coupling (Table 1.). In patients with PH, there was significantly higher prevalence of heart failure (HF) (79 % v.s. 37.5 %, p<.0001). 

Conclusions:

1. The relation between AVF flow and PH is weak. RV-PA coupling is not dependent on AVF flow. Both PH and RV-PA uncoupling are related to current hydration status
2. RV-PA uncoupling is associated with more advanced structural heart changes of both ventricles.
3. PH is present in about one-third of Czech hemodialysis population. HF is the strongest contributor of PH in hemodialysis population.