Role of right ventricular pulmonary arterial coupling to predict acute kidney injury in normotensive patients with acute pulmonary embolism

Acute pulmonary embolism (APE) is a major cause of morbidity and mortality, ranking after myocardial infarction and stroke. Right ventricular (RV) failure, a hemodynamic consequence of APE, can lead to renal congestion and is detectable via echocardiography (1,2,3).

To study the association between RV function and the risk of AKI in APE patients.

This single-center, retrospective study evaluated echocardiographic predictors of acute kidney injury (AKI). AKI was defined as a >0.3 mg/dL increase in plasma creatinine within 48 hours of diagnosis.

350 normotensive patients experiencing a first episode of APE were included. AKI has occurred in 38 patients (11%) (AKI+ group) vs control group-patients without AKI (AKI-). No significant difference was found in terms of age, sex and major comorbidities. Compared to those without AKI, the AKI (+) group presented reduced left ventricular ejection fraction [60% (55–60) vs. 60% (58–64), P = 0.006], larger RV dimensions [41 mm (34–45) vs. 38 mm (33–43), P = 0.04], and a higher prevalence of McConnell’s sign (36.8% vs. 18.6%, P = 0.01). AKI (+) patient have shown reduced RV systolic function [TAPSE: 18 mm (15–23) vs. 22 mm (18–25), P = 0.007] and elevated PASP [43 mmHg (38.5–53.8) vs. 39.2 mmHg (29.5–48.9), P = 0.004]. The TAPSE/PASP index was significantly lower in AKI (+) patients [0.39 (0.29–0.64) vs. 0.55 (0.4–0.8), P < 0.001], and multivariate analysis confirmed it as the only independent predictor of AKI [OR 0.066, 95% CI 0.009–0.472, P = 0.007].

AKI is a notable complication in normotensive APE patients, and the TAPSE/PASP ratio serves as a useful echocardiographic marker for identifying those at increased risk due to RV dysfunction and renal congestion.