Intrarenal hemodynamics as a mirror of systemic vascular damage in HFpEF
J I Jitari, C P I Cabac-Pogorevici, S D Savca, A V Avram, R V RevencoAbstract
Introduction
The ankle–brachial index (ABI) is a well-established, non-invasive marker of peripheral macrovascular disease. In contrast, intrarenal Doppler ultrasound allows an indirect assessment of renal microvascular dysfunction through the evaluation of intrarenal hemodynamics.
Purpose
The aim of this study was to investigate the relationship between ABI and intrarenal hemodynamic parameters in patients with heart failure with preserved ejection fraction (HFpEF), in order to explore the link between systemic macrovascular damage and renal microcirculatory impairment.
Methods
The study included 200 patients diagnosed with HFpEF. All participants underwent comprehensive clinical evaluation, including medical history, cardiovascular risk assessment, and review of ongoing treatments. Laboratory analyses, transthoracic echocardiography, and intrarenal Doppler ultrasound were performed in all patients. Macrovascular involvement was assessed using the ankle–brachial index (ABI). Intrarenal hemodynamic parameters included the renal resistive index (RRI), renal pulsatility index (RPI), acceleration time (AT), renal volume (RV), and the RV/RRI ratio.
Results
When intrarenal hemodynamic parameters were analyzed in relation to peripheral vascular damage assessed by ABI, significantly higher RRI values were observed in patients with HFpEF and pathological ABI compared with those with borderline and normal ABI values (0.715 vs. 0.683 vs. 0.650, p < 0.001). Similar trends were noted for RPI (1.384 vs. 1.335 vs. 1.199, p < 0.001). Conversely, the RV/RRI ratio showed an inverse relationship with ABI, with the highest values observed in patients with normal ABI, decreasing progressively in those with borderline ABI and reaching the lowest levels in patients with peripheral arterial disease (216.8 vs. 204.53 vs. 161.75, p < 0.01).
Conclusions
Intrarenal hemodynamic parameters are closely associated with systemic macrovascular damage in patients with HFpEF. These findings suggest that intrarenal hemodynamics may represent a key pathophysiological link between renal microcirculatory dysfunction and peripheral macrovascular disease in this patient population.