Abstract 18600: Hemodynamic Predictors of Renal Dysfunction in Left Ventricular Systolic Dysfunction and Pulmonary Hypertension

Abstract

Background: There is limited data on hemodynamic predictors of renal function in patients with left ventricular systolic dysfunction and pulmonary hypertension. Our objective was to analyze the strength of correlation between standard and novel hemodynamic indices, including right atrial to pulmonary capillary wedge ratio (RA:PCWP) and pulmonary artery pulsatility index (PAPi), with renal function in patients with systolic dysfunction {left ventricular ejection fraction (LVEF) ≤35%} who had pulmonary hypertension (mean pulmonary artery pressure ≥ 25 mm Hg). Methods: We retrospectively screened 250 patients with systolic dysfunction and pulmonary hypertension, who underwent a right heart catheterization (RHC) between 2007 and 2012 at Einstein Medical Center, Philadelphia. Patients with underlying chronic kidney disease (GFR <60 mL/min/1.73m 2 ) were excluded. Correlation between standard RHC variables, pulmonary artery pulse pressure (PAPP), PAPi (PAPP/RA) and RA:PCWP ratio with renal function were studied. Results: The final cohort consisted of 108 patients, with mean age 59±12 years and 66% male. Forty-six patients had worsening creatinine from the time of admission to RHC. The group with worsening creatinine (n=46) had a higher RA:PCWP ratio (0.64±0.25 vs. 0.52±18; p<0.01) than the group with no change or an improvement in the creatinine (n=59). When comparing these two groups, RA:PCWP ratio was the only hemodynamic variable which was significantly different. Patients with a RA:PCWP ratio of ≥0.86 (n=11) had a higher creatinine at the time of RHC (2.13±0.84 vs. 1.64±0.75 mg/dL; p=0.04) and an increase in creatinine from the time of admission to the RHC (increased by 0.38±0.62 vs. decreased by 0.04±59 mg/dL; p=0.02) when compared to the group with a RA:PCWP ratio <0.86 (n=94). Conclusion: RA:PCWP ratio is a better predictor of renal dysfunction than the standard RHC variables in patients with systolic dysfunction and pulmonary hypertension.