title: Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction.
abstract: BACKGROUND
  Functional renal impairment is a common feature of heart failure with preserved ejection fraction (HFpEF). The link between functional renal impairment and HFpEF remains incompletely understood. With hypertension and diabetes as frequent co-morbidities, patients with HFpEF are at risk of developing intra-renal vascular hemodynamic alterations that may lead to functional renal impairment and impact on prognosis.
  
  
  METHODS
  Renal resistive index (RRI) was non-invasively determined by Doppler ultrasonic examination in 90 HFpEF patients and 90 age- and sex-matched hypertensive patients without evidence of heart failure (HF) who served as controls. Clinical, laboratory and cardiac echocardiography data were obtained in HFpEF patients and controls. To investigate its possible clinical relevance, RRI was evaluated as a prognostic index of all-cause mortality and hospitalization for HF.
  
  
  RESULTS
  Mean RRI was substantially greater in HFpEF patients than in controls (P < 0.0001), while mean blood pressure, glomerular filtration rate, hemoglobin and serum protein levels were significantly lower in HFpEF patients than in controls. On multivariable analysis, mean RRI was independently associated with HFpEF. In addition, increased mean RRI was an independent predictor of poor outcome [hazard ratio = 1.06 95% confidence interval (1.01-1.10), P = 0.007] and remained significantly associated with the outcome after adjustment for univariate predictors that included low mean blood pressure, low hemoglobin concentration and low glomerular filtration rate. Conclusion. Patients with HFpEF exhibit intra-renal vascular hemodynamic alterations. The severity of intra-renal vascular hemodynamic alterations correlates with a poor outcome.
authors.affiliation: Division of Cardiology and Ultrasound, Universitaire de Lille, Lille, France. ennezat@yahoo.com
authors.forename: Pierre Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.forename: Marie
authors.initials: M
authors.lastname: Six-Carpentier
authors.forename: Claire
authors.initials: C
authors.lastname: Pinçon
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Sediri
authors.forename: Pascal
authors.initials: P
authors.lastname: Delsart
authors.forename: Marc
authors.initials: M
authors.lastname: Gras
authors.forename: Claire
authors.initials: C
authors.lastname: Mounier-Véhier
authors.forename: Corinne
authors.initials: C
authors.lastname: Gautier
authors.forename: David
authors.initials: D
authors.lastname: Montaigne
authors.forename: Brigitte
authors.initials: B
authors.lastname: Jude
authors.forename: Philippe
authors.initials: P
authors.lastname: Asseman
authors.forename: Thierry H
authors.initials: TH
authors.lastname: Le Jemtel
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D018608:Ultrasonography, Doppler