Abstract 9126: Renal Venous Stasis Index Reflects Renal Congestion and Predicts Adverse Outcomes in Patients With Heart Failure

Abstract

Background: It has been recently reported that the renal venous stasis index (RVSI) assessed by renal Doppler ultrasonography provides information to stratify pulmonary hypertension (PH) leading to right-sided heart failure. However, the clinical significance of RVSI on heart failure (HF) patients has not been fully examined. We aimed to clarify the associations of RVSI with parameters of cardiac function and right heart catheterization (RHC), as well as with prognosis, in patients with HF. Methods: We performed renal Doppler ultrasonography, echocardiography and RHC in hospitalized patients with HF (n = 388). The RVSI was calculated as follows: RVSI = (cardiac cycle time - venous flow time)/cardiac cycle time. These patients were divided into three groups based on RVSI: RVSI 0 group (RVSI = 0, n = 260, 67%), low RVSI group (0 < RVSI ≤ 0.21, n = 65, 17%) and high RVSI group (RVSI > 0.21, n = 63, 16%). We examined associations between RVSI and parameters of cardiac function and RHC, and followed up for cardiac events such as cardiac death and worsening HF. Results: There were significant correlations between RVSI and right atrial pressure (R = 0.253, P <0.001), right atrial end-systolic 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 periods (median 412 days), cardiac events occurred in 60 patients. In the Kaplan-Meier analysis, accumulated cardiac event rate increased with advancing RVSI (Figure, log-rank, P = 0.001). In the multivariable Cox proportional hazard analysis, cardiac event rate was independently associated with RVSI (hazard ratio, 1.874; 95% confidence interval, 1.023-3.435, P = 0.042). Conclusion: RVSI assessed by renal Doppler ultrasonography reflects right-sided overload and is associated with adverse prognosis in HF patients.