Author + information
- Received March 16, 2017
- Revision received May 4, 2017
- Accepted May 12, 2017
- Published online August 28, 2017.
- Petra Nijst, MDa,b,
- Pieter Martens, MDa,b,
- Matthias Dupont, MDa,
- W.H. Wilson Tang, MDc and
- Wilfried Mullens, MD, PhDa,d,∗ ()
- aDepartment of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- bDoctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- cDepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- dBiomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- ↵∗Address for correspondence:
Dr. Wilfried Mullens, Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
Objectives The goal of this study was to assess: 1) the intrarenal flow in heart failure (HF) patients during the transition from euvolemia to intravascular volume overload; and 2) the relationship between intrarenal flow and diuretic efficiency.
Background Intrarenal blood flow alterations may help to better understand impaired volume handling in HF.
Methods Resistance index (RI) and venous impedance index (VII) were assessed in 6 healthy subjects, 40 euvolemic HF patients with reduced ejection fraction (HFrEF), and 10 HF patients with preserved ejection fraction (HFpEF). Assessments were performed by using Doppler ultrasonography at baseline, during 3 h of intravascular volume expansion with 1 l of hydroxyethyl starch 6%, and 1 h after the administration of a loop diuretic. Clinical parameters, echocardiography, and biochemistry were assessed. Urine output was collected after 3 and 24 h.
Results In response to volume expansion, VII increased significantly in HFrEF patients (0.4 ± 0.3 to 0.7 ± 0.2; p < 0.001) and in HFpEF patients (0.4 ± 0.3 to 0.7 ± 0.2; p = 0.002) but not in healthy subjects (0.2 ± 0.2 to 0.3 ± 0.1; p = 0.622). This outcome was reversed after loop diuretic administration. In contrast, RI did not change significantly after volume expansion. Echocardiographic-estimated filling pressures did not change significantly. VII during volume expansion was significantly correlated with diuretic response in HF patients independent of baseline renal function (R2 = 0.35; p < 0.001).
Conclusions In HF patients, intravascular volume expansion resulted in significant blunting of venous flow before a significant increase in cardiac filling pressures could be demonstrated. The observed impaired renal venous flow is correlated with less diuretic efficiency. Intrarenal venous flow patterns may be of interest for evaluating renal congestion.
- Doppler ultrasonography
- renal resistance index
- venous impedance index
Drs. Nijst, Martens, and Mullens are researchers for the Limburg Clinical Research Program (LCRP) UHasselt–ZOL–Jessa; and supported by the foundation Limburg Sterk Merk, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. Dr. Martens is supported by a doctoral fellowship by the Research Foundation-Flanders (FWO). Drs. Nijst and Dupont are supported by a research grant provided by Vision4Life-Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 16, 2017.
- Revision received May 4, 2017.
- Accepted May 12, 2017.
- 2017 American College of Cardiology Foundation