Intrarenal hemodynamics as prognostic markers in heart failure with preserved ejection fraction
J I Jitari, C P I Cabac-Pogorevici, S D Savca, A V Avram, R V RevencoAbstract
Background
The renal resistive index (RRI) is a Doppler-derived parameter reflecting alterations in renal perfusion and vascular resistance. Recent evidence indicates that RRI is independently associated with heart failure progression. Although closely correlated with estimated glomerular filtration rate (eGFR), RRI appears to provide incremental prognostic information, potentially allowing a more refined assessment of renal dysfunction in patients with congestive heart failure, particularly in ambulatory settings.
Aim
To assess the prognostic value of intrarenal hemodynamic parameters, particularly the renal resistive index, in patients with heart failure with preserved ejection fraction.
Methods
This study included 200 patients who underwent comprehensive clinical evaluation, including medical history, physical examination, and assessment of cardiovascular risk factors and ongoing treatments. Laboratory analyses, transthoracic echocardiography, and intrarenal Doppler ultrasound were performed in all participants. The intrarenal hemodynamic parameters analyzed were renal resistive index (RRI), renal pulsatility index (RPI), acceleration time (AT), renal volume (RV), and the RV/RRI ratio.
Results
Most intrarenal hemodynamic parameters demonstrated a significant association with left ventricular diastolic dysfunction. Patients with diastolic dysfunction exhibited significantly higher RRI values compared with those without diastolic dysfunction (0.676 vs. 0.627, p < 0.001), as well as increased RPI (1.265 vs. 1.146, p < 0.001) and prolonged AT (67.003 vs. 65.131 ms, p < 0.001). Renal volume did not differ significantly between groups. However, the RV/RRI ratio was significantly higher in patients without diastolic dysfunction (215.457 vs. 188.124, p < 0.001).
Conclusions
Intrarenal hemodynamic parameters are strongly associated with left ventricular diastolic dysfunction in patients with heart failure. Among these, RRI emerges as a promising prognostic marker in heart failure with preserved ejection fraction, providing complementary information to conventional measures of renal function.