The renal arterial resistance index: a marker of renal function with an independent and incremental role in predicting heart failure progression
The renal arterial resistance index: a marker of renal function with an independent and incremental role in predicting heart failure progression
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DOI：
10.1002/ejhf.34
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发表时间：
2014-02-01
影响因子：
18.2
通讯作者：
Favale, Stefano
中科院分区：
文献类型：
--
作者：
Ciccone, Marco Matteo;Iacoviello, Massimo;Favale, Stefano
目的肾动脉阻力指数（RRI）是多普勒超声测量肾脏血流的一种指标，它可以反映肾脏血管和实质的异常。本研究的目的是评估临床相关性和RRI的预后相关性在一组患者受慢性心力衰竭（CHF）。方法和结果我们招募了250 CHF门诊患者在一个稳定的临床条件和接受常规治疗。采用脉冲多普勒血流仪测量肾动脉收缩期峰值流速和舒张末期流速。然后计算RRI。通过测量血清肌酐水平和估计肾小球滤过率（GFR）获得标准肾功能评估。在随访期间（21.4 +/- 11.3个月），41例患者发生心力衰竭进展（住院和/或心脏移植和/或因心力衰竭恶化而死亡）。作为连续变量，RRI与单变量[风险比（HR）1.14; 95%置信区间（CI）1.09-1.19; P < 0.001]以及多变量考克斯回归分析（HR 1.08; 95% CI 1.02-1.13; P = 0.004）中的事件相关，校正参考模型的独立预测因素后。当将RRI添加到包括GFR的参考模型中时，根据无类别净重新分类改善和无类别净重新分类改善，（NRI，47%; 95% CI 13-80%; P = 0.006）和综合辨别力改善（IDI，0.034; 95% CI 0.006-0.061;结论肾动脉灌注定量为CHF患者预后提供了一个新的独立预测指标，从而加强其在当前临床实践中的可能作用，以便更好地表征肾功能并对患者的预后进行分层。
Aims The renal arterial resistance index (RRI) is a measure of renal blood flow obtained by Doppler ultrasonography, which has been demonstrated to reflect both vascular and parenchymal renal abnormalities. The aim of the study was to evaluate clinical correlates and the prognostic relevance of RRI in a group of patients affected by chronic heart failure (CHF).Methods and results We enrolled 250 CHF outpatients in a stable clinical condition and receiving conventional therapy. Peak systolic velocity and end-diastolic velocity of a segmental renal artery were obtained by pulsed Doppler flow. Then the RRI was calculated. Standard renal function assessment was obtained by the measurement of creatinine serum levels and the estimation of the glomerular filtration rate (GFR). During follow-up (21.4 +/- 11.3 months), 41 patients experienced heart failure progression (hospitalization and/or heart transplantation and/or death due to worsening heart failure). Considered as a continuous variable, RRI was associated with events at univariate [hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.09-1.19; P < 0.001] as well as at multivariate Cox regression analysis (HR 1.08; 95% CI 1.02-1.13; P = 0.004) after correction for independent predictors of the reference model. When the RRI was added to the reference model including GFR, a significant improvement of reclassification according to both category-free net reclassification improvement (NRI, 47%; 95% CI 13-80%; P = 0.006) and integrated discrimination improvement (IDI, 0.034; 95% CI 0.006-0.061; P = 0.016) was observed.Conclusions Quantification of arterial renal perfusion provides a new parameter that independently predicts CHF patient outcome, thus strengthening its possible role in current clinical practice in order to better characterize renal function and stratify patients' prognosis.