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

Trpkov, Cvetan; Grant, Andrew; Fine, Nowell M.

doi:10.1016/j.cjco.2021.07.010

Cited by 16 publications

(9 citation statements)

References 26 publications

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“…A recent study confirmed the prognostic value of discharge IRVF pattern in patients with ADHF [12]. Moreover, a small study showed an association between sonographic parameter of renal venous congestion with creatinine level rise in ADHF [18]. Though there are several similarities with the aforementioned studies such as determined high levels of renal venous congestion parameters in patients with HF, the key differences of the present study is the longitudinal observation analysing the effect of ADHF treatment on IRVF.…”

Section: Discussionsupporting

confidence: 75%

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

et al. 2023

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Objectives Renal venous congestion due to backward heart failure leads to disturbance of renal function in acute decompensated heart failure (ADHF). Whether decongestion strategies have an impact on renal venous congestion is unknown. Objective was to evaluate changes in intrarenal hemodynamics using intrarenal Doppler ultrasonography (IRD) in patients with heart failure with reduced ejection fraction (HFrEF) and ADHF undergoing recompensation. Methods Prospective observational study in patients with left ventricular ejection fraction (LV-EF) ≤ 35% hospitalized due to ADHF. IRD measurement was performed within the first 48 h of hospitalisation and before discharge. Decongestion strategies were based on clinical judgement according to heart failure guidelines. IRD was used to assess intrarenal venous flow (IRVF) pattern, venous impedance index (VII) and resistance index (RI). Laboratory analyses included plasma creatinine, eGFR and albuminuria. Results A number of 35 patients with ADHF and LV-EF ≤ 35% were included into the study. IRD could be performed in 30 patients at inclusion and discharge. At discharge, there was a significant reduction of VII from a median of 1.0 (0.86–1.0) to 0.59 (0.26–1.0) (p < 0.01) as well as improvement of IRVF pattern categories (p < 0.05) compared to inclusion. Albuminuria was significantly reduced from a median of 78 mg/g creatinine (39–238) to 29 mg/g creatinine (16–127) (p = 0.02) and proportion of patients with normoalbuminuria increased (p = 0.01). Plasma creatinine and RI remained unchanged (p = 0.73; p = 0.43). Discussion This is the first study showing an effect of standard ADHF therapy on parameters of renal venous congestion in patients with HFrEF and ADHF. Doppler sonographic evaluation of renal venous congestion might provide additional information to guide decongestion strategies in patients with ADHF. Graphical abstract

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Section: Discussionsupporting

confidence: 75%

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

et al. 2023

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“…7,13 Previous studies had shown that a higher rank IRVF pattern was associated with a poorer prognosis. 8,9,11 However, our study did not yield the same result. This was probably due to the smaller sample size and the different timeline for the secondary endpoints (i.e.…”

Section: Discussioncontrasting

confidence: 68%

“…4,5 An emerging tool of intrarenal venous flow (IRVF) measurement by Doppler ultrasonography was shown to correlate with renal congestion and could aid in the management of DHF with WRF. [6][7][8] However, its clinical implication is yet to be thoroughly defined, and studies on the relationship between IRVF, clinical degree of congestion, other forms of haemodynamic assessment, and renal outcome are needed.…”

Section: Introductionmentioning

confidence: 99%

Clinical role of intrarenal venous flow patterns in decompensated heart failure with worsening renal function

et al. 2022

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Introduction: The clinical implication of intrarenal venous flow patterns in decompensated heart failure with worsening renal function is unknown. We aimed to study the relationship between intrarenal venous flow patterns, inferior vena cava volume status, caval index, clinical degree of congestion and the renal outcome in patients with decompensated heart failure and worsening renal function. Secondary objectives were to study the combined endpoint of readmission and mortality rate within 30 days (after the last scan) among intrarenal venous flow patterns and the effect of congestion status on the renal outcome. Methods: Twenty-three patients admitted for decompensated heart failure (ejection fraction ⩽40%) with worsening renal function (absolute increase in serum creatinine of 26.5 µmol/L or ⩾1.5-fold increment from baseline) were enrolled in this study. A total of 64 scans were performed. Patients were visited on day 0, 2, 4 and 7 (or earlier if discharged). Patients were called 30 days after discharge to evaluate readmission or mortality. Intrarenal venous flow patterns were ranked from continuous, interrupted, biphasic, to monophasic. Clinical congestion was scored from 0 to 7. Results: Intrarenal venous flow patterns had statistically significant positive correlations with inferior vena cava volume status (Spearman’s ρ, 0.51; p < 0.01) and congestion score ( ρ, 0.65; p < 0.01) and a significant negative correlation with caval index ( ρ, −0.53; p < 0.01). Intrarenal venous flow patterns were not significant in predicting estimated glomerular filtration rate improvement or the combined endpoint. Reduced congestion significantly predicted an estimated glomerular filtration rate improvement on the following scan day ( p = 0.04, odds ratio = 4.3, 95% confidence interval = 1.1–17.2). Conclusion: Although intrarenal venous flow patterns correlate with other congestive parameters, clinical congestion status rather than intrarenal venous flow patterns predicted the renal outcome.

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“…Abnormal hepatic venous reflux is the initial manifestation of fluid overload. Several studies have demonstrated that assessing the maximum velocity of the S- and D-waves in the hepatic veins can aid in fluid management decisions [ 47 ]. Changes in the hepatic veins static D-wave during resuscitation of shock are related to volume responsiveness.…”

Section: Clinical Utility Of Vrs In Critically Ill Patientsmentioning

confidence: 99%

The Importance of Venous Reflux Status Evaluation in the Intensive Care Unit

2024

Aging dis

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The current management approach for critically ill patients emphasizes maintaining adequate cardiac output and mean arterial pressure. Recently, researchers have increasingly emphasized the clinical significance of venous reflux. Bedside venous Doppler ultrasonography offers continuous, dynamic, and quantifiable assessment of the venous reflux status. In this review, we explore the pertinent literature on assessing the venous reflux status in critically ill patients. We propose a bedside ultrasonographic evaluation method that starts with the hepatic veins and progresses to the portal, renal and intrarenal, femoral, and pulmonary veins. The clinical significance of venous reflux status evaluation is discussed in terms of its effect on right ventricular function, the functioning of other organs, and the guidance of fluid therapy. Overall, we underscore the importance of venous reflux status evaluation in critically ill patients and highlight the benefits of incorporating bedside ultrasonography for the continuous monitoring of venous return.

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

Cited by 16 publications

References 26 publications

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

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

Clinical role of intrarenal venous flow patterns in decompensated heart failure with worsening renal function

The Importance of Venous Reflux Status Evaluation in the Intensive Care Unit

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