Renal Venous Stasis Index Reflects Renal Congestion and Predicts Adverse Outcomes in Patients With Heart Failure

Abstract

BackgroundIt has been recently reported that the renal venous stasis index (RVSI) assessed by renal Doppler ultrasonography provides information to stratify pulmonary hypertension that can lead to right-sided heart failure (HF). However, the clinical significance of RVSI in HF patients has not been sufficiently examined. We aimed to examine the associations of RVSI with parameters of cardiac function and right heart catheterization (RHC), as well as with prognosis, in patients with HF.MethodsWe performed renal Doppler ultrasonography, echocardiography and RHC in hospitalized patients with HF (n = 388). RVSI was calculated as follows: RVSI = (cardiac cycle time-venous flow time)/cardiac cycle time. The patients were classified to three groups based on RVSI: control group (RVSI = 0, n = 260, 67%), low RVSI group (0 < RVSI ≤ 0.21, n = 63, 16%) and high RVSI group (RVSI > 0.21, n = 65, 17%). We examined associations of RVSI with parameters of cardiac function and RHC, and followed up for cardiac events defined as cardiac death or worsening HF.ResultsThere were significant correlations of RVSI with mean right atrial pressure (mRAP; R = 0.253, P < 0.001), right atrial area (R = 0.327, P < 0.001) and inferior vena cava diameter (R = 0.327, P < 0.001), but not with cardiac index (R = −0.019, P = 0.769). During the follow-up period (median 412 days), cardiac events occurred in 60 patients. In the Kaplan–Meier analysis, the cumulative cardiac event rate increased with increasing RVSI (log-rank, P = 0.001). In the multivariate Cox proportional hazard analysis, the cardiac event rate was independently associated with RVSI (high RVSI group vs. control group: hazard ratio, 1.908; 95% confidence interval, 1.046–3.479, P = 0.035).ConclusionRVSI assessed by renal Doppler ultrasonography reflects right-sided overload and is associated with adverse prognosis in HF patients.

Doppler study of portal vein and renal venous velocity predict the appropriate fluid response to diuretic in ICU: a prospective observational echocardiographic evaluation

“…We calculated intra-and inter-observer reproducibility. Intra and inter-observer reproducibility was 10% (4-16) and 15% (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), respectively. RRI (Renal resistive index) and RVI (renal venous impedance index) were measured using a transparietal 5 MHz pulsed-wave Doppler probe.…”

“…The VEXUS score was higher in patients with appropriate diuretic-induced fluid depletion (2 (0-3) vs 1 (0-2), p = 0.002). At 2 h, the portal pulsatility index was higher in patients with appropriate diuretic-induced fluid depletion (34% (23-54) vs 24% (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), p = 0.001). None of the other echocardiographic parameters differed between the two groups, even rightsided echocardiographic parameters and the IVC diameter (Additional file 1: Table S1).…”

“…Measurement of portal pulsatility index, renal venous impedance, and/or the construction of the VEXUS score (venous ultrasound congestion score) are associated with venous congestion, occurrence of acute renal failure, and clinical prognosis of patients [ 3 , 11 ]. Of these parameters, the pulsatility portal index and the venous renal flow are two promising parameters that have been associated with venous congestion and fluid overload [ 12 – 14 ]. The pulsatility portal index has been demonstrated to increase with fluid expansion when patients were unable to increase their cardiac output (i.e., fluid unresponsive) [ 15 ].…”

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

“…The heterogenous nature of AKI in an unselected cohort of critically ill patients could have contributed to the discrepancy. In the context of HF, flow alterations in renal parenchymal veins have shown to confer worse prognosis in terms of car-diovascular morbidity and death [97,98]. A key advantage of these Doppler waveforms is that they are dynamic and allow monitoring the response to decongestive therapy in real time [99][100][101][102][103][104][105].…”

The disturbance variants of renal blood flow in young age persons with connective tissue dyplasiasigns

“…Значения показателя резистентности (IR) в правой магистральной артерии почек и dV ven в магистральной вене у респондентов с СТД на фоне болей в суставах имели прямую корреляцию умеренной силы с морфометрическими параметрами сердца (ИММЛЖ, КДР, КДО, КСР, КСО, УО) в связи с анатомическими особенностями расположения почек и функциональной зависимостью от кровотока в нижней полой вене и функции сердца [16,17]. При этом наличие у лиц с СТД и СБС связей почечного кровотока с морфометрическими показателями сердца может быть использовано как одно из показаний для доказательной оценки состояния сердца и почечного кровотока у этой категории молодых людей.…”