title: Renal artery stenosis: an innocent bystander or an independent predictor of worse outcome in patients with chronic heart failure? A magnetic resonance imaging study.
abstract: OBJECTIVE
  To investigate the prognostic impact of atherosclerotic renovascular disease in patients with chronic heart failure.
  
  
  RESULTS
  Patients with heart failure due to left ventricular systolic dysfunction underwent cardiac magnetic resonance imaging and contrast-enhanced magnetic resonance angiography. Renal artery stenosis (RAS) was defined as a luminal narrowing >50%. Of the 366 patients investigated, 112 (31%) had RAS, of whom 41 had bilateral RAS. Patients with RAS were older (P < 0.001), had higher blood pressure (P < 0.001), and worse renal function (P = 0.001). In addition, these patients had more admissions and more prolonged hospital stays because of vascular events (0.09 ± 0.26 vs. 0.02 ± 0.16 admissions/per patient/year; P < 0.001; and 1.26 ± 5.79 vs. 0.31 ± 2.54 days/per patient/year; P < 0.001, respectively) and worse prognosis (hazard ratio 1.60, 95% confidence interval 1.10-2.34, P = 0.015). However, in multivariable analysis, a history of diabetes mellitus, decreasing haemoglobin, and increasing left ventricular end-systolic volume index, but not age and RAS, were independently related to outcome.
  
  
  CONCLUSIONS
  RAS is a common finding in patients suffering from heart failure. Although it is associated with an increased vascular morbidity, it is not an independent predictor of mortality.
authors.affiliation: Department of Cardiology, Academic Unit, University of Hull, Kingston-upon-Hull, UK. cbourantas@gmail.com
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.forename: Huan P
authors.initials: HP
authors.lastname: Loh
authors.forename: Elena I
authors.initials: EI
authors.lastname: Lukaschuk
authors.forename: Antony
authors.initials: A
authors.lastname: Nicholson
authors.forename: Saeed
authors.initials: S
authors.lastname: Mirsadraee
authors.forename: Farqad M
authors.initials: FM
authors.lastname: Alamgir
authors.forename: Ann C
authors.initials: AC
authors.lastname: Tweddel
authors.forename: Duncan F
authors.initials: DF
authors.lastname: Ettles
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rigby
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikitin
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; D016001:Confidence Intervals; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007902:Length of Stay; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000473:pathology*; D013223:Statistics as Topic