Brief Report
The Effect of Decongestion on Intrarenal Venous Flow Patterns in Patients With Acute Heart Failure

https://doi.org/10.1016/j.cardfail.2020.09.003Get rights and content

Abstract

Background

Discontinuous intrarenal venous flow patterns, as assessed by renal Doppler ultrasound examination, are associated with changes in hemodynamics such as volume expansion and poorer diuretic response in patients with heart failure (HF). We aimed to study intrarenal venous and arterial flow patterns after decongestive treatment in patients with acute HF.

Methods and Results

Fifteen patients with acute HF were enrolled. Intrarenal venous and arterial flow patterns were assessed at baseline, 1 hour after administration of loop diuretics, at day 2 and day 3. Among patients hospitalized for acute HF, 13 (87%) had a discontinuous venous flow pattern at admission. After decongestive treatment, a significant improvement of the venous impedance index (P = .021) and venous discontinuity index (P = .004) was observed at day 3 compared with baseline. There was no effect on the intrarenal arterial flow patterns.

Conclusions

In patients who exhibit discontinuous renal venous flow patterns hospitalized for decongestive treatment owing to acute HF led to a normalization of intrarenal venous flow to a continuous pattern.

Section snippets

Study Design and Study Population

In this observational exploratory study, we assessed intrarenal flow patterns at different time points during decongestive treatment in patients with acute HF. Patients were prospectively enrolled in a single tertiary HF clinic between October 2018 and February 2019. In general, subjects were eligible for enrollment if they were older than 18 years of age and able to provide written informed consent. Patients were only enrolled on week days during day time hours. For more specific inclusion and

Results

A total of 15 patients with acute HF were enrolled. The median age of the enrolled patients with acute HF was 81 years, and 67% were male (Supplementary Table 2). All patients had signs and symptoms of congestion at time of enrollment, median N terminal pro blood natriuretic peptide was 3931 ng/L, median estimated glomerular filtration rate 50 mL/min/1.73 m2, and median left ventricular ejection fraction 43.1%. HF was most commonly owing to ischemic heart disease (60%).

On admission, 13 patients

Discussion

The present study was a proof-of-concept, exploratory study investigating the effect of decongestive treatment on renal arterial and venous flow patterns, as assessed by ultrasound examination. Our study showed that venous renal flow patterns were discontinuous in 87% of patients at admission for acute HF, improved significantly during decongestive therapy, and were normalized to a continuous venous flow pattern in a significant number of patients at discharge.

Conclusions

In patients who exhibit discontinuous renal venous flow patterns hospitalized for acute HF, decongestive therapy led to a normalization of intrarenal venous flow to a continuous pattern.

Disclosures

Drs Dauw, Somers, Damman, Nijst, Metalidis, and Dupont have nothing to disclose. Dr ter Maaten is supported by a grant from the UMCG (Mandema grant). Dr Martens is supported by a doctoral fellowship by the Research Foundation Flanders (FWO; grant no. 1127917N). Dr Martens and Dr Mullens are researchers for the Limburg Clinical Research Program UHasselt-ZOL-Jessa and supported by the Limburg Sterk Merk foundation, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital.

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