2026-05-31T08:56:19Z https://repub.eur.nl/oai

oai:repub.eur.nl:120371 2023-11-26T18:35:36Z

urn:NBN:nl:ui:15-1765/120371 2023-11-26T18:35:36 mods http://hdl.handle.net/1765/120371 hdl:1765/120371 urn:NBN:nl:ui:15-1765/120371 doi:10.1161/JAHA.119.013584 http://hdl.handle.net/1765/120371 https://repub.eur.nl/pub/120371/Repub_120371_O-A.pdf application/pdf Filesize: 2415168 bytes born digital Erasmus MC: University Medical Center Rotterdam sht supporting host Husain-Syed, F. (Faeq) Husain-Syed F. (Faeq) aut author Birk, H.-W. (Horst-Walter) Birk H.-W. (Horst-Walter) aut author Ronco, C. (Claudio) Ronco C. (Claudio) aut author Schörmann, T. (Tanja) Schörmann T. (Tanja) aut author Tello, K. (Khodr) Tello K. (Khodr) aut author Richter, M.J. (Manuel J.) Richter M.J. (Manuel J.) aut author Wilhelm, J. (Jochen) Wilhelm J. (Jochen) aut author Sommer, N. (Natascha) Sommer N. (Natascha) aut author E.W. Steyerberg (Ewout) Steyerberg Ewout aut author Bauer, P. (Pascal) Bauer P. (Pascal) aut author Walmrath, H.-D. (Hans-Dieter) Walmrath H.-D. (Hans-Dieter) aut author W. Seeger (Werner) Seeger Werner aut author P.A. McCullough (Peter) McCullough Peter aut author H. Gall (Henning) Gall Henning aut author H.A. Ghofrani Ghofrani H.A. aut author Background Persistent congestion with deteriorating renal function is an important cause of adverse outcomes in heart failure. We aimed to characterize new approaches to evaluate renal congestion using Doppler ultrasonography. Methods and Results We enrolled 205 patients with suspected or prediagnosed pulmonary hypertension (PH) undergoing right heart catheterization. Patients underwent renal Doppler ultrasonography and assessment of invasive cardiopulmonary hemodynamics, echocardiography, renal function, intra-abdominal pressure, and neurohormones and hydration status. Four spectral Doppler intrarenal venous flow patterns and a novel renal venous stasis index (RVSI) were defined. We evaluated PH-related morbidity using the Cox proportional hazards model for the composite end point of PH progression (hospitalization for worsening PH, lung transplantation, or PH-specific therapy escalation) and all-cause mortality for 1-year after discharge. The prognostic utility of RVSI and intrarenal venous flow patterns was compared using receiver operating characteristic curves. RVSI increased in a graded fashion across increasing severity of intrarenal venous flow patterns (P<0.0001) and was significantly associated with right heart and renal function, intra-abdominal pressure, and neurohormonal and hydration status. During follow-up, the morbidity/mortality end point occurred in 91 patients and was independently predicted by RVSI (RVSI in the third tertile versus referent: hazard ratio: 4.72 [95% CI, 2.10-10.59; P<0.0001]). Receiver operating characteristic curves suggested superiority of RVSI to individual intrarenal venous flow patterns in predicting outcome (areas under the curve: 0.789 and 0.761, respectively; P=0.038). Conclusions We propose RVSI as a conceptually new and integrative Doppler index of renal congestion. RVSI provides additional prognostic information to stratify PH for the propensity to develop right heart failure. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT03039959. Journal of the American Heart Association 22536 20479980 8 21 2019-11-05 en English cardiorenal syndromes intrarenal venous flow patterns pulmonary hypertension renal Doppler ultrasonography venous congestion Doppler-Derived Renal Venous Stasis Index in the Prognosis of Right Heart Failure text info:eu-repo/semantics/article 107893932 http://purl.org/eprint/accessRights/OpenAccess