Clinical Implications of Intrarenal Hemodynamic Evaluation by Doppler Ultrasonography in Heart Failure

• Published in: JACC. Heart failure Vol. 4; no. 8; pp. 674 - 682
• Main Authors: Iida, Noriko, BA, Seo, Yoshihiro, MD, Sai, Seika, MD, Machino-Ohtsuka, Tomoko, MD, Yamamoto, Masayoshi, MD, Ishizu, Tomoko, MD, Kawakami, Yasushi, MD, Aonuma, Kazutaka, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Adult; Aged; Aged, 80 and over; Blood Flow Velocity; cardiorenal syndrome; Cardiovascular; Cardiovascular Diseases - mortality; Doppler ultrasound; Echocardiography; Female; heart failure; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Hemodynamics; Hospitalization; Humans; Kaplan-Meier Estimate; Kidney - blood supply; Kidney - diagnostic imaging; Male; Middle Aged; Multivariate Analysis; Prognosis; Proportional Hazards Models; renal congestion; Ultrasonography, Doppler; Vascular Resistance; eGFR; RAP; heart failure; estimated glomerular filtration rate; BNP; resistance index; brain natriuretic peptide; PCWP; pulmonary capillary wedge pressure; blood urea nitrogen; intrarenal venous flow; Doppler ultrasound; prognosis; cardiorenal syndrome; intrarenal Doppler ultrasonography; right atrial pressure; RI; VII; BUN; IRD; renal congestion; IRVF; venous impedance index; HF
• ISSN: 2213-1779; 2213-1787
• DOI: 10.1016/j.jchf.2016.03.016

Abstract Objectives This study clarified the characteristics of intrarenal Doppler ultrasonography (IRD) profiles and their prognostic implications in heart failure (HF). Background IRD can assess intrarenal hemodynamics. Methods Initially, 224 patients with HF were prospectively enrolled; 151 inpatients were enrolled during hospitalization for HF, and 73 were outpatients in our institution. In IRD profiles of interlobar vessels, the arterial resistance index (RI), venous impedance index (VII), and intrarenal venous flow (IRVF) pattern were assessed. Patients were followed to evaluate the associations with 1-year prognosis. Primary endpoints included death from cardiovascular disease and unplanned hospitalization for HF. Results Finally, 217 patients with adequate IRD images were enrolled. IRD profiles were associated with conventional risk factors for HF. In particular, IRVF was associated with mean right atrial pressure (RAP); 3 IRVF patterns were stratified by RAP (in a continuous pattern: 5.4 ± 2.5; in a biphasic pattern: 9.5 ± 3.5; and in a monophasic pattern: 14.9 ± 4.3 mm Hg; p < 0.001). In addition, the monophasic IRVF pattern had a poorer prognosis than the other patterns (log rank p < 0.001), and prognosis was poorer for the biphasic pattern than for the continuous flow pattern (log rank p = 0.01). Multivariate Cox proportional hazard model analysis revealed that IRVF patterns were associated with the endpoints, independent of other HF risk factors. Conclusions IRVF patterns, rather than RI, depended on RAP, suggesting a correlation with renal congestion. In addition, IRVF patterns strongly correlated with clinical outcomes independent of RAP and other risk factors and might provide additional information to stratify vulnerable HF patients.