Journal Article

Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction

Pierre Vladimir Ennezat, Sylvestre Maréchaux, Marie Six-Carpentier, Claire Pinçon, Ibrahim Sediri, Pascal Delsart, Marc Gras, Claire Mounier-Véhier, Corinne Gautier, David Montaigne, Brigitte Jude, Philippe Asseman and Thierry H. Le Jemtel

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 12, pages 3908-3913
Published in print December 2011 | ISSN: 0931-0509
Published online March 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr116
Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction

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Background. Functional renal impairment is a common feature of heart failure with preserved ejection fraction (HFpEF). The link between functional renal impairment and HFpEF remains incompletely understood. With hypertension and diabetes as frequent co-morbidities, patients with HFpEF are at risk of developing intra-renal vascular hemodynamic alterations that may lead to functional renal impairment and impact on prognosis.

Methods. Renal resistive index (RRI) was non-invasively determined by Doppler ultrasonic examination in 90 HFpEF patients and 90 age- and sex-matched hypertensive patients without evidence of heart failure (HF) who served as controls. Clinical, laboratory and cardiac echocardiography data were obtained in HFpEF patients and controls. To investigate its possible clinical relevance, RRI was evaluated as a prognostic index of all-cause mortality and hospitalization for HF.

Results. Mean RRI was substantially greater in HFpEF patients than in controls (P < 0.0001), while mean blood pressure, glomerular filtration rate, hemoglobin and serum protein levels were significantly lower in HFpEF patients than in controls. On multivariable analysis, mean RRI was independently associated with HFpEF. In addition, increased mean RRI was an independent predictor of poor outcome [hazard ratio = 1.06 95% confidence interval (1.01–1.10), P = 0.007] and remained significantly associated with the outcome after adjustment for univariate predictors that included low mean blood pressure, low hemoglobin concentration and low glomerular filtration rate.

Conclusion. Patients with HFpEF exhibit intra-renal vascular hemodynamic alterations. The severity of intra-renal vascular hemodynamic alterations correlates with a poor outcome.

Keywords: heart failure with preserved ejection fraction; intra-renal vascular resistance; ultrasound Doppler of renal vasculature

Journal Article.  3516 words.  Illustrated.

Subjects: Nephrology

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