Atherosclerotic renal artery stenosis is prevalent in cardiorenal patients but not associated with left ventricular function and myocardial fibrosis as assessed by cardiac magnetic resonance imaging

Abstract

BackgroundAtherosclerotic renal artery stenosis (ARAS) is common in cardiovascular diseases and associated with hypertension, renal dysfunction and/or heart failure. There is a paucity of data about the prevalence and the role of ARAS in the pathophysiology of combined chronic heart failure (CHF) and chronic kidney disease (CKD). We investigated the prevalence in patients with combined CHF/CKD and its association with renal function, cardiac dysfunction and the presence and extent of myocardial fibrosis.MethodsThe EPOCARES study (ClinTrialsNCT00356733) investigates the role of erythropoietin in anaemic patients with combined CHF/CKD. Eligible subjects underwent combined cardiac magnetic resonance imaging (cMRI), including late gadolinium enhancement, with magnetic resonance angiography of the renal arteries (MRA).ResultsMR study was performed in 37 patients (median age 74 years, eGFR 37.4 ± 15.6 ml/min, left ventricular ejection fraction (LVEF) 43.3 ± 11.2%), of which 21 (56.8%) had ARAS (defined as stenosis >50%). Of these 21 subjects, 8 (21.6%) had more severe ARAS >70% and 8 (21.6%) had a bilateral ARAS >50% (or previous bilateral PTA). There were no differences in age, NT-proBNP levels and medication profile between patients with ARAS versus those without. Renal function declined with the severity of ARAS (p = 0.03), although this was not significantly different between patients with ARAS versus those without. Diabetes mellitus was more prevalent in patients without ARAS (56.3%) against those with ARAS (23.8%) (p = 0.04). The presence and extent of late gadolinium enhancement, depicting myocardial fibrosis, did not differ (p = 0.80), nor did end diastolic volume (p = 0.60), left ventricular mass index (p = 0.11) or LVEF (p = 0.15). Neither was there a difference in the presence of an ischemic pattern of late enhancement in patients with ARAS versus those without.ConclusionsARAS is prevalent in combined CHF/CKD and its severity is associated with a decline in renal function. However, its presence does not correlate with a worse LVEF, a higher left ventricular mass or with the presence and extent of myocardial fibrosis. Further research is required for the role of ARAS in the pathophysiology of combined chronic heart and renal failure.

Cardiac Function In Renovascular Hypertensive Patients With and Without Renal Dysfunction

“…30 RVHT is prevalent in patients with combined congestive heart failure and chronic kidney disease, but its severity does not correlate with LVEF, LVMI, or the extent of myocardial fibrosis. 31 In addition to age, recent cardiovascular or cerebrovascular events, baseline eGFR, and presence of RAS with severe renal dysfunction were independent predictors of mortality. Cherr et al demonstrated increased dialysis-free survival among patients showing improvement in eGFR after renal artery revascularization.…”

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

“…A substantial number of HF patients with CKD exhibit renal artery stenosis. [26] In the present study, no patients with known renal artery stenosis were included, however, there was no formal exclusion. In accordance with relevant previous reports investigating IRD in heart diseases [6,7], in the present study IRD was predominantly performed in the right renal vessels.…”

Development of chronic heart failure in a young woman with hypertension associated with renal artery stenosis with preserved renal function

“…Nevertheless, it remains unclear whether atherosclerotic renovascular disease defined as renal artery stenosis >50% might be associated with worsening of cardiac function. Emans et al 2 found that renal artery stenosis is more prevalent in patients with combined chronic heart failure and chronic kidney disease, but it is not correlated with worsening in LVEF, left ventricular volumes and mass or myocardial fibrosis. In a study by de Silva et al 3 renal artery stenosis was associated with an increase in morbidity and mortality in patients with chronic heart failure.…”