{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:13:40Z","timestamp":1777958020724,"version":"3.51.4"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Right ventricular (RV) dysfunction in chronic kidney disease (CKD) remains underrecognized. The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE\/sPAP) reflects RV\u2010pulmonary arterial coupling, but its relationship with CKD severity is unknown. To evaluate the association between TAPSE\/sPAP ratio and CKD stage severity and assess age\u2010related effect modification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study enrolled 120 participants: 40 patients with stage I\u2013II CKD, 40 with stage III\u2013IV CKD, and 40 healthy controls. All underwent echocardiography and nephrologist evaluation. Proportional odds regression models adjusted for cardiovascular risk factors evaluated the TAPSE\/sPAP\u2010CKD association. ROC analysis assessed discriminatory performance. Age\u2010stratified analyses (&lt;65\u00a0vs. \u226565 years) evaluated effect modification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      TAPSE\/sPAP ratio declined progressively across CKD stages (controls: 0.67\u00a0\u00b1\u00a00.11, stage I\u2013II: 0.61\u00a0\u00b1\u00a00.13, stage III\u2013IV: 0.53\u00a0\u00b1\u00a00.13\u00a0mm\/mmHg;\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a00.01). Each 0.10\u2010unit decrease was independently associated with advanced CKD (adjusted OR 2.08, 95% CI 1.49\u20132.89,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). TAPSE\/sPAP ratio achieved the highest AUC (0.734, 95% CI 0.625\u20130.833), outperforming TAPSE alone (AUC 0.615; DeLong\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.049), while statistically comparable to sPAP (AUC 0.715; DeLong\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.400). Age\u2010stratified analysis revealed excellent performance in patients &lt;65 years (AUC 0.819, sensitivity 78.6%, specificity 86.8%) but limited utility in those \u226565 years (AUC 0.579;\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.015). Random forest analysis identified age (35.8%) and TAPSE\/sPAP (22.0%) as dominant predictors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TAPSE\/sPAP ratio is an independent marker of CKD severity enabling non\u2010invasive detection of RV\u2010PA uncoupling, with excellent discriminatory performance in younger but limited utility in older patients, suggesting that age\u2010specific interpretation and integration with renal biomarkers are recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/echo.70461","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T12:17:52Z","timestamp":1776428272000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Age\u2010Stratified Performance of the TAPSE\/sPAP Ratio as a Marker of Right Ventricular\u2010Pulmonary Arterial Coupling in Chronic Kidney Disease"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6750-2601","authenticated-orcid":false,"given":"G\u00f6rkem","family":"Y\u0131ld\u0131z","sequence":"first","affiliation":[{"name":"Department of Cardiology Faculty of Medicine Y\u00fcksek \u0130htisas University  Ankara T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0838-2037","authenticated-orcid":false,"given":"Tolga","family":"Kunak","sequence":"additional","affiliation":[{"name":"Department of Cardiology Faculty of Medicine Akdeniz University  Antalya T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/kisup.2012.64"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.14745"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741\u2010014\u20109460\u20109"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1038\/ki.1995.132","article-title":"Congestive Heart Failure in Dialysis Patients: Prevalence, Incidence, Prognosis and Risk Factors","volume":"47","author":"Harnett J. 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