Prognostic Impact of Changes in Intrarenal Venous Flow Pattern in Patients With Heart Failure
Section snippets
Study Population and Protocol
Patients with HF who underwent repetitive echocardiographic examinations with IRD assessments at the University of Tsukuba Hospital from 2013 to 2017 were enrolled retrospectively. The observation period continued until August 2019. The diagnosis of HF was made according to the Framingham criteria.9 Patients were excluded if they were <20 years of age or undergoing renal replacement therapy.
IRD assessments were performed at the discretion of the patient's providers to assess the congestion
Baseline Characteristics and Longitudinal Changes in IRVF
During the study period, 293 patients underwent ≥1 IRD assessment. Among them, 110 (110/293, 37.5%) with HF and repetitive IRD assessment were registered in this study, of whom 2 were excluded because of inadequate IRD images. Finally, the analysis included 108 patients. The patients were initially classified into the continuous (n = 33, 30.6%) and discontinuous (n = 75, 69.4%) groups according to their IRVF pattern at baseline. The latter consisted of patients with a biphasic discontinuous
Discussion
In this study, we demonstrated 3 major findings. First, the IRVF pattern could change depending on the HF status over the clinical course. Second, a persistent discontinuous IRVF pattern was associated with progression of renal impairment. Third, a discontinuous IRVF pattern during follow-up correlated strongly with clinical outcomes, independent of IRVF pattern at baseline. These results suggested that a longitudinal change in intrarenal hemodynamics had a prognostic impact in patients with HF.
Conclusions
The IRVF patterns changed depending on the status of HF. Persistent or worsened renal congestion, represented by discontinuous flow patterns during the clinical courses, indicated a poor prognosis accompanied by renal impairment in patients with HF. The findings suggest that the IRVF by the intrarenal Doppler method may be a feasible, noninvasive biomarker for stratifying vulnerable patients with HF in clinical settings. Further studies are needed to establish the evidence.
References (26)
- et al.
Freedom from congestion predicts good survival despite previous class IV symptoms of heart failure
Am Heart J
(2000) - et al.
Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease
J Am Coll Cardiol
(2009) - et al.
Importance of venous congestion for worsening of renal function in advanced decompensated heart failure
J Am Coll Cardiol
(2009) - et al.
Abnormal liver function in relation to hemodynamic profile in heart failure patients
J Card Fail
(2010) - et al.
Clinical implications of intrarenal hemodynamic evaluation by Doppler ultrasonography in heart failure
JACC Heart Fail
(2016) - et al.
Intrarenal flow alterations during transition from euvolemia to intravascular volume expansion in heart failure patients
JACC Heart Fail
(2017) - et al.
Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance
J Am Soc Echocardiogr
(2017) - et al.
Noninvasive evaluation of right atrial pressure
J Am Soc Echocardiogr
(2013) Congestive renal failure: the pathophysiology and treatment of renal venous hypertension
J Card Fail
(2012)- et al.
Renal impairment and outcomes in heart failure: systematic review and meta-analysis
J Am Coll Cardiol
(2006)