Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients
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 progr...
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| Format: | Article |
| Language: | English |
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MDPI AG
2018-11-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/5/4/52 |
| _version_ | 1818173737844867072 |
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| author | Agata Puzzovivo Francesco Monitillo Pietro Guida Marta Leone Caterina Rizzo Dario Grande Marco Matteo Ciccone Massimo Iacoviello |
| author_facet | Agata Puzzovivo Francesco Monitillo Pietro Guida Marta Leone Caterina Rizzo Dario Grande Marco Matteo Ciccone Massimo Iacoviello |
| author_sort | Agata Puzzovivo |
| collection | DOAJ |
| description | 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; <i>p</i> < 0.001), pattern D (HR 7.16; 95% CI: 3.69⁻13.9; <i>p</i> < 0.001) and pattern E (HR 8.94; 95% CI: 4.65⁻17.2; <i>p</i> < 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; <i>p</i>: 0) and of pattern D or E (HR: 1.90; 95% CI: 1.16⁻3.12; <i>p</i>: 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; <i>p</i> < 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. |
| first_indexed | 2024-12-11T19:33:16Z |
| format | Article |
| id | doaj.art-c13914c8736c471aab838fbee72c102b |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-12-11T19:33:16Z |
| publishDate | 2018-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-c13914c8736c471aab838fbee72c102b2022-12-22T00:53:14ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252018-11-01545210.3390/jcdd5040052jcdd5040052Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure OutpatientsAgata Puzzovivo0Francesco Monitillo1Pietro Guida2Marta Leone3Caterina Rizzo4Dario Grande5Marco Matteo Ciccone6Massimo Iacoviello7Cardiology Unit, IRCCS istituto tumori “Giovanni Paolo II” di Bari, ItaliaEmergency Cardiology Unit, University Policlinic Hospital, 70124 Bari, ItalyCardiovascular Department, Scientific Clinical Institutes Maugeri, Institute of Cassano delle Murge, 70124 Bari, ItalyCardiology Unit, SS Annunziata Hospital, 74123 Taranto, ItalyCardiovascular Department, Scientific Clinical Institutes Maugeri, Institute of Cassano delle Murge, 70124 Bari, ItalySchool of Cardiology, University of Bari, 70124 Bari, ItalySchool of Cardiology, University of Bari, 70124 Bari, ItalyUniversity Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, ItalyAim 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; <i>p</i> < 0.001), pattern D (HR 7.16; 95% CI: 3.69⁻13.9; <i>p</i> < 0.001) and pattern E (HR 8.94; 95% CI: 4.65⁻17.2; <i>p</i> < 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; <i>p</i>: 0) and of pattern D or E (HR: 1.90; 95% CI: 1.16⁻3.12; <i>p</i>: 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; <i>p</i> < 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.https://www.mdpi.com/2308-3425/5/4/52cardiorenal syndromeprognosisheart failurerenal Dopplercongestion |
| spellingShingle | Agata Puzzovivo Francesco Monitillo Pietro Guida Marta Leone Caterina Rizzo Dario Grande Marco Matteo Ciccone Massimo Iacoviello Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients Journal of Cardiovascular Development and Disease cardiorenal syndrome prognosis heart failure renal Doppler congestion |
| title | Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients |
| title_full | Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients |
| title_fullStr | Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients |
| title_full_unstemmed | Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients |
| title_short | Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients |
| title_sort | renal venous pattern a new parameter for predicting prognosis in heart failure outpatients |
| topic | cardiorenal syndrome prognosis heart failure renal Doppler congestion |
| url | https://www.mdpi.com/2308-3425/5/4/52 |
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