Valvular and/or Non-valvular Aortic Pathology Can Bias the Ultrasonographic Diagnosis of Renal Artery Stenosis

Bardelli, Moreno; Cavressi, Monica; Furlanis, Giulia

doi:10.1016/j.ultrasmedbio.2019.07.414

Cited by 2 publications

(12 citation statements)

References 14 publications

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“…In a retrospective pilot study, we evaluated the implications of AVS per se in determining attenuation of renal parenchymal flowmetric indices, while being applied in ultrasonographic screening for RAS. 3 We observed that the presence of AVS was the only predictor for the unexpected reduction in the AImax in non-stenotic kidneys. Therefore, the current study aimed to confirm this observation in an ad hoc prospective study.…”

Section: Introductionmentioning

confidence: 58%

“…A recent retrospective study suggested that the presence of aortic stenosis is the major determinant in generating false positives in ultrasonographic diagnosis of RAS. 3 This was based on measurement of systolic acceleration indices at the level of the renal parenchymal vessels, resulting in compromise in diagnostic accuracy. Our data support this previous finding because we found that patients with severe AVS had a significantly lower AImax value compared with those with a mild to intermediate degree of AVS in the RPA and perirenal aorta (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we re-analyzed the database related to our previous retrospective study on a population of patients who underwent diagnostic work-up for suspected RAS. 3 . After excluding all patients with severe aortic stenosis from the database, the diagnostic accuracy of the AImax in the first stage of ultrasonographic screening for stenosis of the renal arteries improved by increasing the positive predictive power from 54.7% to 87.9%, while the excellent negative predictive power was unchanged.…”

Section: Discussionmentioning

confidence: 99%

“…The AImax is useful for screening, but has a relatively low specificity. [1][2][3] However, at every level of the arterial tree, the cycle flow shape is determined by interaction of the hemodynamic profile upstream and downstream, and at a distance from the observation point. 4,5 Proximal hemodynamic resistance, such as aortic stenosis, can affect the aortic stiffness, the aortic pulse wave, and vascular impedance.…”

Section: Introductionmentioning

confidence: 99%

“…The AImax is useful for screening, but has a relatively low specificity. 1–3 However, at every level of the arterial tree, the cycle flow shape is determined by interaction of the hemodynamic profile upstream and downstream, and at a distance from the observation point. 4,5…”

Section: Introductionmentioning

confidence: 99%

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Relationship between aortic valve stenosis and the hemodynamic pattern in the renal circulation, and restoration of the flow wave profile after correction of the valvular defect

et al. 2020

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Objective The index of maximal systolic acceleration ([AImax]: maximal systolic acceleration of the Doppler waveform divided by peak systolic velocity) shows diagnostic accuracy in screening of renal artery stenosis. This study aimed to determine whether an upstream factor of resistance, such as aortic valve stenosis (AVS), can affect Doppler parameters detected in the peripheral arteries. Methods In this prospective study, we measured the AImax in non-stenotic renal interlobar arteries of 62 patients with AVS. Patients were divided into three groups on the basis of severity of valvulopathy as follows: mild-to-moderate AVS (M-AVS; n = 24), intermediate AVS (I-AVS; n = 15), and severe AVS (S-AVS; n = 23) based on Nishimura’s criteria. Results The AImax in the renal parenchymal arteries was significantly lower in the S-AVS group (8.9 ± 3.6 s−1) than in the M-AVS (15.3 ± 3.8 s−1) and I-AVS groups (16.7 ± 5.2 s−1). The AImax was positively correlated with the aortic valve area and inversely correlated with the tranvalvular aortic pressure gradient. After aortic valve replacement, the AImax significantly increased from 10.7 ± 4.0 s−1 at baseline to 19.3 ± 4.4 s−1. Conclusions Proximal resistance can lead to diagnostic bias of Doppler parameters that are applied in the diagnosis of peripheral vasculopathies, particularly in renal artery stenosis.

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Section: Introductionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relationship between aortic valve stenosis and the hemodynamic pattern in the renal circulation, and restoration of the flow wave profile after correction of the valvular defect

et al. 2020

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Accuracy of Duplex Ultrasound for Detecting Renal Artery Stenosis: A Systematic Review

MacLeod,

Kivell,

Shivgulam

et al. 2024

Journal for Vascular Ultrasound

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Background: Duplex ultrasound (DUS) is a well-tolerated, noninvasive imaging technique. Renal artery stenosis (RAS)—a narrowing of the arteries that supply the kidney—is involved in the cause of renal failure, and its gold-standard method of detection is digital subtraction angiography (DSA). Whether DUS is a suitable alternative to DSA or other angiographic modalities has only been reviewed up to 2005, producing mixed results with studies based on older ultrasound technology without a measurement of study quality. Purpose: To provide an up-to-date review of the diagnostic accuracy of DUS for the diagnosis of RAS in comparison with angiography. Methods: Our registered systematic review (DOI: 10.17605/OSF.IO/SE9VN) examined articles post-2005. Studies must have compared RAS diagnosis between DUS and angiography. Sources were searched in November 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier (1749 citations; final: n = 34; DSA only: n = 9). Study quality was assessed using the Quality Assessment of Diagnostic Studies 2 tool and results are presented narratively. A total of 2968 (1281 females) patients were included. Duplex ultrasound exhibited moderately high agreement with DSA and other well-established angiographic criteria with the existing literature having low risk of bias and low concern for patient applicability. Studies exhibiting low agreement were generally in smaller samples or used unique definitions of stenosis. Conclusions: Improved study reporting, consistent definitions of stenosis, and a common statistical battery are needed.

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Valvular and/or Non-valvular Aortic Pathology Can Bias the Ultrasonographic Diagnosis of Renal Artery Stenosis

Cited by 2 publications

References 14 publications

Relationship between aortic valve stenosis and the hemodynamic pattern in the renal circulation, and restoration of the flow wave profile after correction of the valvular defect

Relationship between aortic valve stenosis and the hemodynamic pattern in the renal circulation, and restoration of the flow wave profile after correction of the valvular defect

Accuracy of Duplex Ultrasound for Detecting Renal Artery Stenosis: A Systematic Review

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