Intrarenal Doppler ultrasonography in patients with HFrEF and acute decompensated heart failure undergoing recompensation

• Published in: Clinical research in cardiology Vol. 112; no. 8; pp. 1087 - 1095
• Main Authors: Wallbach, M., Valentova, M., Schroeter, M. R., Alkabariti, A., Iraki, I., Leha, A., Tampe, D., Hasenfuß, G., Zeisberg, M., Hellenkamp, K., Koziolek, M. J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2023; Springer Nature B.V
• Subjects: Albuminuria; Cardiology; Congestion; Congestive heart failure; Creatinine; Doppler effect; Ejection fraction; Evaluation; Heart failure; Heart Failure - diagnostic imaging; Hemodynamics; Humans; Hyperemia; Medicine; Medicine & Public Health; Observational studies; Original Paper; Renal failure; Renal function; Stroke Volume; Ultrasonic imaging; Ultrasonography, Doppler; Ventricle; Ventricular Dysfunction, Left; Ventricular Function, Left; Cardiorenal syndrome; Acute decompensated heart failure; Renal function; Albuminuria; Renal venous congestion
• DOI: 10.1007/s00392-023-02184-6
• ISSN: 1861-0684

Objectives Renal venous congestion due to backward heart failure leads to disturbance of renal function in acute decompensated heart failure (ADHF). Whether decongestion strategies have an impact on renal venous congestion is unknown. Objective was to evaluate changes in intrarenal hemodynamics using intrarenal Doppler ultrasonography (IRD) in patients with heart failure with reduced ejection fraction (HFrEF) and ADHF undergoing recompensation. Methods Prospective observational study in patients with left ventricular ejection fraction (LV-EF) ≤ 35% hospitalized due to ADHF. IRD measurement was performed within the first 48 h of hospitalisation and before discharge. Decongestion strategies were based on clinical judgement according to heart failure guidelines. IRD was used to assess intrarenal venous flow (IRVF) pattern, venous impedance index (VII) and resistance index (RI). Laboratory analyses included plasma creatinine, eGFR and albuminuria. Results A number of 35 patients with ADHF and LV-EF ≤ 35% were included into the study. IRD could be performed in 30 patients at inclusion and discharge. At discharge, there was a significant reduction of VII from a median of 1.0 (0.86–1.0) to 0.59 (0.26–1.0) (p < 0.01) as well as improvement of IRVF pattern categories (p < 0.05) compared to inclusion. Albuminuria was significantly reduced from a median of 78 mg/g creatinine (39–238) to 29 mg/g creatinine (16–127) (p = 0.02) and proportion of patients with normoalbuminuria increased (p = 0.01). Plasma creatinine and RI remained unchanged (p = 0.73; p = 0.43). Discussion This is the first study showing an effect of standard ADHF therapy on parameters of renal venous congestion in patients with HFrEF and ADHF. Doppler sonographic evaluation of renal venous congestion might provide additional information to guide decongestion strategies in patients with ADHF. Graphical abstract