Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction
Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction
复制标题
DOI：
10.1093/ndt/gfr116
复制
发表时间：
2011-12-01
影响因子：
6.1
通讯作者：
Le Jemtel, Thierry H.
中科院分区：
文献类型：
--
作者：
Ennezat, Pierre Vladimir;Marechaux, Sylvestre;Le Jemtel, Thierry H.
背景资料。功能性肾功能损害是射血分数保留的心力衰竭的常见特征。功能性肾损害和HFpEF之间的联系仍不完全清楚。由于高血压和糖尿病是常见的并存疾病，HFpEF患者有发生肾内血管血流动力学改变的风险，这些改变可能导致肾功能损害并影响预后。应用多普勒超声对90例HFpEF患者和90例年龄、性别相匹配的无心衰证据的高血压患者的肾阻力指数(RRI)进行了无创性测定。HFpEF患者和对照组的临床、实验室和心脏超声心动图数据均获得。为了探讨其可能的临床相关性，我们评估了RRI作为预测高血压病患者全因死亡率和住院时间的指标。HFpEF患者的平均RRI显著高于对照组(P<；0.0001)，而平均血压、肾小球滤过率、血红蛋白和血清蛋白水平显著低于对照组。多变量分析显示，平均RRI与HFpEF独立相关。此外，平均RRI升高是不良预后的独立预测因子[风险比=1.0695%可信区间(1.01-1.10)，P-0.007]，并且在调整了包括平均血压、低血红蛋白浓度和低肾小球滤过率在内的单变量预测因子后，仍与预后显著相关。HFpEF患者表现为肾内血管血流动力学改变。肾内血管血流动力学改变的严重程度与不良预后相关。
Background. Functional renal impairment is a common feature of heart failure with preserved ejection fraction (HFpEF). The link between functional renal impairment and HFpEF remains incompletely understood. With hypertension and diabetes as frequent co-morbidities, patients with HFpEF are at risk of developing intra-renal vascular hemodynamic alterations that may lead to functional renal impairment and impact on prognosis.Methods. Renal resistive index (RRI) was non-invasively determined by Doppler ultrasonic examination in 90 HFpEF patients and 90 age-and sex-matched hypertensive patients without evidence of heart failure (HF) who served as controls. Clinical, laboratory and cardiac echocardiography data were obtained in HFpEF patients and controls. To investigate its possible clinical relevance, RRI was evaluated as a prognostic index of all-cause mortality and hospitalization for HF.Results. Mean RRI was substantially greater in HFpEF patients than in controls (P < 0.0001), while mean blood pressure, glomerular filtration rate, hemoglobin and serum protein levels were significantly lower in HFpEF patients than in controls. On multivariable analysis, mean RRI was independently associated with HFpEF. In addition, increased mean RRI was an independent predictor of poor outcome [ hazard ratio = 1.06 95% confidence interval (1.01-1.10), P - 0.007] and remained significantly associated with the outcome after adjustment for univariate predictors that included low mean blood pressure, low hemoglobin concentration and low glomerular filtration rate.Conclusion. Patients with HFpEF exhibit intra-renal vascular hemodynamic alterations. The severity of intra-renal vascular hemodynamic alterations correlates with a poor outcome.