Abstract
Aim of the study: In chronic heart failure (CHF) patients, renal congestion plays a key role in determining the progression of renal dysfunction and a worse prognosis. The aim of this study was to define the role of Doppler venous patterns reflecting renal congestion that predict heart failure progression. Methods: We enrolled outpatients affected by CHF, in stable clinical conditions and in conventional therapy. All patients underwent a clinical evaluation, routine chemistry, an echocardiogram and a renal echo-Doppler. Pulsed Doppler flow recording was performed at the level of interlobular renal right veins in the tele-expiratory phase. The venous flow patterns were divided into five groups according to the fluctuations of the flow. Type A and B were characterized by a continuous flow, whereas type C was characterized by a short interruption or reversal flow during the end-diastolic or protosystolic phase. Type D and E were characterized by a wide interruption and/or reversal flow. The occurrence of death and/or of heart transplantation and/or of hospitalization due to heart failure worsening was considered an event during follow-up. Results: During a median follow-up of 38 months, 126 patients experienced the considered end-point. Venous pattern C (HR 4.04; 95% CI: 2.14–7.65; p < 0.001), pattern D (HR 7.16; 95% CI: 3.69–13.9; p < 0.001) and pattern E (HR 8.94; 95% CI: 4.65–17.2; p < 0.001) were all associated with events using an univariate Cox regression analysis. Moreover, both the presence of pattern C (HR: 1.79; 95% CI: 1.09–2.97; p: 0) and of pattern D or E (HR: 1.90; 95% CI: 1.16–3.12; p: 0.011) remained significantly associated to events using a multivariate Cox regression analysis after correction for a reference model with an improvement of the overall net reclassification index (0.46; 95% CI 0.24–0.68; p < 0.001). Conclusions: Our findings demonstrate the independent and incremental role of Doppler venous patterns reflecting renal congestion in predicting HF progression among CHF patients, thus suggesting its possible utility in daily clinical practice to better characterize patients with cardio-renal syndrome.
Highlights
Over the last few decades, there has been a growing interest in the role of renal impairment in determining a worse prognosis of patients affected by chronic heart failure (CHF) [1,2,3]
In a population of outpatients and hospitalized heart failure patients, it has been recently demonstrated that the presence of an intra-renal intermittent venous flow with a biphasic or monophasic pattern [10] is associated with high central venous pressure, renal congestion and a worse prognosis
Two patients were excluded because their renal arterial resistance index (RRI) were not valuable and another three patients were in dialytic treatment
Summary
Over the last few decades, there has been a growing interest in the role of renal impairment in determining a worse prognosis of patients affected by chronic heart failure (CHF) [1,2,3] In this setting it has been suggested that renal Doppler ultrasonography could have a role in detecting renal flow impairment and to better characterize renal function [4,5,6,7]. In this study, no data has been reported regarding the pattern observed in pre-eclamptic patients in which a reversal flow correspondent to right atrial contraction has been observed This pattern seems to be between those showing a continuous and intermittent monophasic flow and is associated with an increased renal venous impedance index [11]
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