Intrarenal Doppler ultrasonography reflects hemodynamics and predicts prognosis in patients with heart failure

Abstract

We aimed to clarify clinical implications of intrarenal hemodynamics assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in heart failure (HF). We performed a prospective observational study, and examined IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n = 341). Seven patients were excluded in VTI analysis due to unclear imaging. The patients were divided into groups based on (A) VTI: high VTI (VTI ≥ 14.0 cm, n = 231) or low VTI (VTI < 14.0 cm, n = 103); and (B) IRVF patterns: monophasic (n = 36) or non-monophasic (n = 305). We compared post-discharge cardiac event rate between the groups, and right-heart catheterization was performed in 166 patients. Cardiac index was lower in low VTI than in high VTI (P = 0.04), and right atrial pressure was higher in monophasic than in non-monophasic (P = 0.03). In the Kaplan–Meier analysis, cardiac event rate was higher in low VTI and monophasic groups (P < 0.01, respectively). In the Cox proportional hazard analysis, the combination of low VTI and a monophasic IRVF pattern was a predictor of cardiac events (P < 0.01). IRD imaging might be associated with cardiac output and right atrial pressure, and prognosis.

Simplified Academic Research Consortium for High Bleeding Risk (ARC-HBR) Definition Predicts Bleeding Events in Patients With Heart Failure

“…As HF progresses, organ hypoperfusion and congestion worsen. [53][54][55] Low cardiac output and increased central venous pressure in patients with HF alter gastrointestinal function and cause gastrointestinal bleeding. 27,56 Moreover, once gastrointestinal bleeding occurs, it is associated with higher mortality in both patients with CAD and those with HF.…”

Point of care venous Doppler ultrasound: Exploring the missing piece of bedside hemodynamic assessment

“…Multiple studies have shown that IRVD alterations are not merely a reflection of increased RAP, but also strong predictors of adverse clinical outcomes in patients with compensated[ 27 ] and decompensated heart failure[ 48 ], those undergoing cardiac surgery[ 45 ], patients with pulmonary hypertension and right heart failure[ 47 ].…”

Pathophysiology of Cardiorenal Syndrome and Use of Diuretics and Ultrafiltration as Volume Control

“… 42) The role of the RI in predicting worse outcomes was also studied in the setting of HF with reduced ejection fraction, and the RI was independently associated with composite endpoints including progression, hospitalization, and death due to acute decompensated HF. 43) A higher RI value was also associated with the use of high doses of loop diuretics; additionally, higher values of the RI could predict poor diuretic response and identify patients prone to diuretic resistance, possibly because increased renal resistances lead to reduced delivery of diuretic drugs to the site of action. However, the Doppler technique for assessing the renal venous and arterial waveforms requires expertise, and validation is necessary to ensure consistency of Doppler waveform sampling by operators.…”