title: Impact of central venous pressure on cardiorenal interactions in adult patients with congenital heart disease after biventricular repair.
abstract: BACKGROUND
  Cardiorenal interactions adversely impact the prognosis in heart failure patients an effect which crucially involves increased central venous pressure (CVP). However, it is unclear whether the same pathophysiology operates in adults with congenital heart disease (CHD).
  
  
  OBJECTIVE
  The present study was designed to assess cardiorenal interactions in adults with CHD after biventricular repair.
  
  
  RESULTS
  We measured the kidney length (KL, cm/m) and renal resistive index (RI) in 77 consecutive patients and 30 controls. We also measured hemodynamics, plasma B-type natriuretic peptide level, 24-hour creatinine clearance, and peak oxygen uptake in each patient. The CVP correlated with the KL (r = 0.44, P <.001) and the RI was greater in the patients (P <.0001). The high RI was independently determined by the CVP, aortic pressure, and cardiac index (P <.05-.001), and correlated with the 24-hour creatinine clearance (r = -0.30, P <.05). The RI correlated closely with the neurohumoral activations and peak oxygen uptake (|r| = 0.45-0.50, P <.0001), and the patients with a traditional criteria of high RI (≥0.70) had a higher incidence of cardiovascular events that required unscheduled hospitalization (hazard ratio = 2.78, 95% confidence interval 1.26-6.10, P <.05). Multivariate Cox model with the cutoff values of KL ≥68 cm/m and RI ≥0.74 revealed that a greater KL (hazard ratio = 4.03, 95% confidence interval 1.46-11.1, P <.01) as well as B-type natriuretic peptide (P <.001) independently predicted the events.
  
  
  CONCLUSIONS
  Hemodynamics, especially a high CVP, independently predicted the enlarged kidney and abnormal intrarenal flow dynamics that are closely associated with heart failure severity and cardiovascular events in adults with CHD after biventricular repair.
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan. hohuchi@hsp.ncvc.go.jp
authors.forename: Hideo
authors.initials: H
authors.lastname: Ohuchi
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ikado
authors.forename: Kanae
authors.initials: K
authors.lastname: Noritake
authors.forename: Aya
authors.initials: A
authors.lastname: Miyazaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Yasuda
authors.forename: Osamu
authors.initials: O
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D018572:Disease-Free Survival; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005919:Glomerular Filtration Rate; D006330:Heart Defects, Congenital / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010101:Oxygen Consumption; D010359:Patient Readmission; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012079:Renal Circulation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014690:Venous Pressure; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D003404:Creatinine