Cardiac function response to stenting in atherosclerotic renal artery disease with and without heart failure: results from the Carmel study

Abstract

Aims Consensus‐derived guidelines recommend renal stenting for patients with atherosclerotic renal artery disease (ARAD) and heart failure (HF). The aim of this prospective multi‐centre observational study was to verify our hypothesis that changes in E/e′, an echocardiographic correlate of left ventricular (LV) filling pressure, following renal stenting may differ between ARAD patients with and without HF. Methods and results This study enrolled de novo ARAD patients undergoing renal stenting at 14 institutions. The primary endpoint was the difference in E/e′ change between ARAD patients with and without HF. Clinical and echocardiographic data were prospectively collected at baseline, the day following renal stenting, and 1 month and 6 months afterwards. ARAD patients with HF were defined as patients with New York Heart Association (NYHA) Class 2 and more, or a history of HF hospitalization. A total of 76 patients were included, and 39% were ARAD patients with HF. ARAD patients with HF had significantly lower estimated glomerular filtration rate ( P = 0.028) and higher NYHA functional class ( P < 0.001) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score ( P = 0.001) than ARAD patients without HF. Also, ARAD patients with HF had significantly lower LV ejection fraction ( P = 0.003) and e′‐velocity ( P = 0.003) and higher E/e′ ratio ( P = 0.001), left atrial volume index (LAVI) ( P = 0.046), LV end‐diastolic volume (LVEDV) ( P = 0.001), LV end‐systolic volume (LVESV) ( P = 0.001), and LV mass index ( P = 0.009) than ARAD patients without HF. All procedures were successful. In contrast to blood pressure and renal function, there was a significant interaction in E/e′ ( P interaction < 0.001) between time and HF, and ARAD patients with HF showed a significant ( P < 0.001) decrease in E/e′ albeit those without HF. By the same token, there was a significant interaction in NYHA class ( P interaction < 0.001), MLHFQ score ( P interaction = 0.018), E‐velocity ( P interaction = 0.002), LAVI ( P interaction = 0.001), LVEDV ( P interaction = 0.003), and LVESV ( P interaction = 0.001) between time and HF with a significant improvement in all these variables in ARAD patients with HF (NYHA class, P = 0.001; MLHFQ score, P = 0.002; E‐velocity, P = 0.005; LAVI,...

Revascularization for controlling hypertension and improving cardiorenal failure in Leriche syndrome

“…7 Increasing attention has been paid to flash pulmonary oedema and congestive heart failure associated with atherosclerotic renal artery disease. 8 Kawarada et al 9 reported that renal stenting significantly improved left ventricular filling pressure in patients with atherosclerotic renal artery disease and heart failure; however, in previous studies, renal artery stenting did not reduce blood pressure or the number of cardiovascular or renal events better than optimal medical therapy. 6 Axillofemoral bypass reportedly improved congestive heart failure in a patient with aortic coarctation complicating Takayasu arteritis 10 ; however, post-operative improvement was not observed with heart or renal failure caused by Leriche syndrome.…”

“…Increasing attention has been paid to flash pulmonary oedema and congestive heart failure associated with atherosclerotic renal artery disease 8 . Kawarada et al 9 . reported that renal stenting significantly improved left ventricular filling pressure in patients with atherosclerotic renal artery disease and heart failure; however, in previous studies, renal artery stenting did not reduce blood pressure or the number of cardiovascular or renal events better than optimal medical therapy 6 …”

Clinical efficacy of sacubitril-valsartan combined with acute ST-segment elevation myocardial infarction after reperfusion: A systematic review and meta-analysis

“…In another prospective study, including 125 patients with heart failure, after the use of sacubitril-valsartan in the treatment phase, there was a significant improvement in LVEDV compared with the initial (206 ± 71 vs. 197 ± 72 mL) ( 55 ). Kawarada et al ( 56 ) studied the cardiac function of patients with atherosclerotic renal artery disease with or without heart failure after stent implantation. They found that the mortality rate decreased 6 months after stent implantation, LVEF, left atrial volume index, left ventricular end systolic volume and left ventricular mass index improved significantly.…”

A Retrospective Analysis for Risk Factors and Early Prognosis of Delayed Withdrawal Extracorporeal Membrane Oxygenation After Lung Transplantation

“…NYHA grade, right ventricular function, left ventricular function, and LVEF were important methods to assess patient's cardiac functional status. 9,10 With the deterioration of cardiac function, the perioperative circulation support became increasingly important. 11,12 Herein, we found that the application of V-A-ECMO was associated with NYHA grade for recipients, indicating that when a decision needed to be made regarding whether or not to continue V-A-ECMO support at the end of surgery, it was easier for the clinicians to maintain the ECMO for patient with the NYHA grade of III/IV.…”