title: Epidemiology, associated factors, and prognostic outcomes of renal artery stenosis in chronic heart failure assessed by magnetic resonance angiography.
abstract: Our aim was to determine the prevalence, morbidity, and mortality associated with the presence of significant renal artery stenosis (RAS) in patients with chronic heart failure (HF), and to explore the use of angiotensin-converting enzyme (ACE) inhibitors and diuretics in this population during a 3-year follow-up period. We identified 97 patients with significant renal dysfunction (RD, defined as a calculated glomerular filtration rate of <60 ml/min) and 38 patients without RD, with ejection fractions of <40%. A stenosis of >50% using magnetic resonance angiography of the renal arteries was used to define significant RAS. Seventy-three (54%) patients had significant RAS of >or=1 artery. Mean follow-up time was 37.3 (+/- 7.9) months. Compared with patients with no significant RAS, these patients were on higher doses of diuretics, lower doses of ACE inhibitors, had prolonged hospital admissions, were admitted with exacerbation of HF, and had a higher mortality (p = 0.007 for mortality). In conclusion, RAS is common in patients with chronic HF, especially among patients with RD and is a predictor of a poor clinical outcome. Interventional trials on renal revascularization are underway that contain subsets of patients with HF that may provide evidence on how best to manage RAS in this setting.
authors.affiliation: Academic Cardiology, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom. ramesh@desilva84.freeserve.co.uk
authors.forename: Ramesh
authors.initials: R
authors.lastname: de Silva
authors.forename: Huan
authors.initials: H
authors.lastname: Loh
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rigby
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikitin
authors.forename: Klaus K A
authors.initials: KK
authors.lastname: Witte
authors.forename: Kevin
authors.initials: K
authors.lastname: Goode
authors.forename: Sunil
authors.initials: S
authors.lastname: Bhandari
authors.forename: Anthony
authors.initials: A
authors.lastname: Nicholson
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012077:Renal Artery / Q000473:pathology; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics