title: Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis.
abstract: BACKGROUND
  Renal artery stenosis (RAS) impacts the pathogenesis and control of heart failure (HF) and may further contribute to increased cardiovascular morbidity and mortality in HF patients. However, the long-term effects of renal artery revascularization on cardiovascular outcomes in HF patients are not well studied.
  
  
  METHODS
  The prevalence of HF and its effects on all-cause mortality were studied in 163 consecutive patients with systemic hypertension and chronic kidney disease (serum creatinine >2 mg/dL) who underwent percutaneous transluminal renal angioplasty (PTRA) with stenting for atherosclerotic RAS. In addition, in 100 patients with RAS and coexistent HF, we compared the impact of medical treatment (n = 50) versus PTRA (n = 50) on clinical outcomes.
  
  
  RESULTS
  HF (predominantly normal ejection fraction) was present in 50/163 (31%) patients with systemic hypertension and chronic kidney disease (serum creatinine >2 mg/ dL) undergoing PTRA for RAS and represented the major predictor of all-cause mortality in these patients. When compared with sex-matched RAS and HF patients treated medically, PTRA with stenting was associated with a significant decrease in the New York Heart Association Functional Class (1.9 +/- 0.8 versus 2.6 +/- 1.0, P < 0.04) and a 5-fold reduction in the number of hospitalizations. However, renal artery revascularization did not impact mortality.
  
  
  CONCLUSIONS
  HF was present in one-third of patients with renal dysfunction and atherosclerotic RAS who were referred for PTRA. The presence of HF was associated with a significantly increased risk of death after PTRA with stenting. Renal artery revascularization resulted in improved HF control and a reduction in HF hospitalizations.
authors: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Garvan C
authors: GC
authors: Kane
authors: Nancy
authors: N
authors: Xu
authors: Erik
authors: E
authors: Mistrik
authors: Tomas
authors: T
authors: Roubicek
authors: Anthony W
authors: AW
authors: Stanson
authors: Vesna D
authors: VD
authors: Garovic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure / Q000502:physiology; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012039:Regional Blood Flow / Q000502:physiology; D012077:Renal Artery / Q000503:physiopathology*; D012078:Renal Artery Obstruction / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome