Doppler-Derived Intrarenal Venous Flow Mirrors Right-Sided Heart Hemodynamics in Patients With Cardiovascular Disease

Abstract

Background: Interruption in Doppler intrarenal venous flow (IRVF) has been used in assessing renal congestion and in the prediction of prognosis of cardiovascular diseases. However, there is a paucity of pathophysiological knowledge, so we aimed to clarify the determinants of IRVF interruption. Methods and Results:Intrarenal Doppler studies were performed within 24 h before right-side catheterization studies. The interruption in IRVF in 73 patients was divided into a continuous pattern, and 4 discontinuous types based on the timing of interruption. Type 1, with an interruption in early systole, was associated with a-wave elevation of right atrial pressure (RAP). Type 2, with an interruption in early diastole, was associated with v-wave elevation, tricuspid regurgitation (TR), and right ventricular dysfunction. Both Type 1 and 2 were observed even in the normal range of mean RAP. Type 3, with an interruption throughout systole, was observed in advanced right heart failure patients with markedly elevated RAP, particularly elevated x-descend and atrial fibrillation. Finally, Type 4, with limited flow at systole, was observed in 2 of the patients with pulmonary arterial hypertension.Conclusions: IRVF interruption was closely related to RAP elevation at each specific point of the cardiac cycle rather than to mean RAP levels, suggesting that the characteristics of IRVF mirror right-sided heart hemodynamics, not mean RAP.

Liver Congestion Assessed by Hepatic Vein Waveforms in Patients With Heart Failure

“…20,21,32 From these reports, in this study, we divided the HV waveforms into 3 categories according to the position of the V wave above or below the baseline as a new classification. Similar to previous reports regarding renal congestion, [24][25][26] Doppler HV waveforms in this study were found to be associated with CVP. However, measurement of HV waveforms seemed to be superior to those of intrarenal venous flow pattern, in terms of ease of measurement and accuracy of CVP, because of their closer anatomic proximity to the heart.…”

“…In patients with atrial fibrillation, the C wave was used instead of the A wave. 20,25 Based on previous studies, [20][21][22][23] we focused on the shapes and positions of the V wave. We classified HV waveforms in accordance with the shape and position of the V wave into 3 patterns (Fig 2 ) and divided the total 350 HF patients into 3 groups: those in whom the continuous flow pattern or V wave was ambiguous (C group), those in whom the V wave ran under the baseline (U group), and those who had a reversed V wave (R group).…”

“…[20][21][22][23] With regard to intrarenal venous congestion, it has recently been reported that Doppler intrarenal venous flow pattern is simply classified by the presence or absence of systolic and diastolic interruption and reflects CVP. [24][25][26] These interruptions were associated with an elevated A wave and an elevated V wave in intrarenal venous waveforms, and the elevated V wave was caused by increased CVP and right ventricular dysfunction.…”

Intrarenal Doppler Ultrasound Renal Venous Stasis Index Correlates With Acute Cardiorenal Syndrome in Patients With Acute Decompensated Heart Failure

“…Seo et al showed that IRD flow patterns correlated with right atrial hemodynamics among 73 patients who underwent right heart catheterization. 20 Right ventricular dysfunction, atrial fibrillation and TR were important determinates of the RA pressure waveforms as well as the IRD flow patterns. The IRD flow patterns were sensitive to changes in specific RA pressure waveforms rather than the mean right atrial pressure.…”

Hyponatremia and Renal Venous Congestion in Heart Failure Patients

“…But the HF patients with discontinuous pattern of IRVF had a poorer prognosis, with survival at 12 months less than 40% [ 33 ]. IRVF pattern represents a prognosis predictor in HF patients; it was correlated with the serum natremia ( p < 0.05) and logBNP ( p = 0.009) [ 34 ]. Puzzovivo et al demonstrated that the discontinuous pattern of IRVF has a negative prognostic in HF patients ( p < 0.001) [ 35 ].…”