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Value of Renal Vascular Doppler Sonography in Cardiorenal Syndrome Type 1
Beytullah Çakal1, Özgür Ulaş Özcan1, Mehmet Onur Omaygenç1
1Department of Cardiology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey.
Insights
Renal Doppler parameters like venous impedance index and arterial resistive index can predict kidney function improvement in cardiorenal syndrome type 1 patients receiving diuretic therapy. Higher admission values indicate better response to treatment.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Cardiorenal syndrome (CRS) type 1 involves worsening kidney function in acute decompensated heart failure.
- Persistent systemic venous congestion is linked to renal dysfunction in CRS type 1.
- Investigating renal Doppler parameters can offer insights into therapeutic responses.
Purpose of the Study:
- To evaluate changes in renal Doppler parameters during diuretic therapy for CRS type 1.
- To determine if renal vascular indices predict improvement in renal function.
Main Methods:
- Patients with CRS type 1 were identified from hospital admissions for heart failure.
- Serial measurements of renal venous impedance index (VII) and arterial resistive index (ARI) were performed using Doppler sonography.
Main Results:
- Patients showing creatinine improvement with diuresis had significantly higher admission VII and ARI compared to non-improvers.
- A high admission ARI independently predicted serum creatinine improvement with diuretic therapy (OR, 6.25; P = .003).
Conclusions:
- Renal vascular Doppler parameters, specifically ARI, may guide diagnostic and therapeutic strategies in CRS type 1.
- These non-invasive measures could help optimize decongestive therapy for heart failure patients with renal dysfunction.
Objectives:
Worsening of renal function in a patient with acute decompensated heart failure is called cardiorenal syndrome (CRS) type 1. Recent studies have shown an association of persistent systemic venous congestion with renal dysfunction. This trial was set up to investigate the changes of renal Doppler parameters with diuretic therapy in patients with CRS type 1.
Methods:
Cases of CRS type 1 were identified among patients hospitalized for decompensated heart failure. Serial measurements of the renal venous impedance index (VII) and arterial resistive index (ARI) were calculated by pulsed wave Doppler sonography.
Results:
A total of 30 patients who had creatinine improvement with diuresis (group 1) and 34 patients without any improvement (group 2) were analyzed. Patients in group 1 had higher median VII and ARI (VII, 0.86 versus 0.66; P < .001; ARI, 0.78 versus 0.65; P < .001) on admission. A high ARI on admission (odds ratio, 6.25; 95% confidence interval, 1.84-14.3; P = .003) predicted the improvement of serum creatinine levels with diuretic therapy independent of confounding factors in patients with CRS type 1.
Conclusions:
Renal vascular Doppler parameters might offer guidance on the diagnostic and therapeutic strategies in prescribing decongestive therapy for decompensated heart failure.
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