title: Prognostic Significance of the Renal Resistive Index After Renal Artery Revascularization in the Context of Flash Pulmonary Edema.
abstract: OBJECTIVE
  To evaluate the prognostic value of the renal resistive index (Ri) after renal artery revascularization in the context of flash pulmonary edema.
  
  
  METHODS
  Between 2000 and 2008, 43 patients (mean age 72.1±10.9 years; 23 women) underwent renal artery angioplasty/stenting in the context of flash pulmonary edema. Intrarenal Ri was assessed using duplex ultrasound. The majority (97.7%) of patients had hypertension, and nearly half (46.5%) had diabetes mellitus. For this retrospective analysis, the patients were divided into 2 groups according to the median Ri (<0.8 and ≥0.8) of the population. A Cox proportional hazards model was used to identify predictors of all-cause mortality (primary endpoint) and rehospitalization for heart failure; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). The mean follow-up was 49.8±30.6 months.
  
  
  RESULTS
  There was no difference between the groups regarding clinical characteristics. A high Ri was associated with the risk of all-cause death (HR 2.54, 95% CI 1.15 to 5.60, p=0.021). This relationship was still statistically significant after adjustment for age, gender, diabetes, glomerular filtration rate, and treatment with a renin-angiotensin system inhibitor (HR 1.74, 95%CI 1.08 to 2.81, p=0.032). A high Ri was also associated with cardiovascular death in unadjusted and adjusted analyses. In contrast, a high Ri was not associated with the risk of rehospitalization for heart failure.
  
  
  CONCLUSIONS
  After renal artery revascularization for flash pulmonary edema, a high intrarenal Ri is independently associated with all-cause mortality. Determination of the intrarenal Ri after this procedure may be useful for identifying at-risk patients.
authors.affiliation: Médecine Vasculaire et HTA, Hôpital Cardiologique, CHRU de Lille, France delsartpascal@yahoo.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Delsart
authors.affiliation: Service de Cardiologie, Centre Hospitalier de Boulogne sur Mer, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Meurice
authors.affiliation: Radiologie Vasculaire, Hôpital Cardiologique, CHRU de Lille, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Midulla
authors.affiliation: Clinique de Cardiologie, Hôpital Cardiologique, CHRU de Lille, France Faculté de Médecine de Lille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
authors.affiliation: Faculté de Médecine de Lille, France Chirurgie Vasculaire, Hôpital Cardiologique, CHRU Lille, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Haulon
authors.affiliation: Médecine Vasculaire et HTA, Hôpital Cardiologique, CHRU de Lille, France Faculté de Médecine de Lille, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Mounier-Vehier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012079:Renal Circulation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014655:Vascular Resistance
keywords: angioplasty; flash pulmonary edema; prognosis; renal artery stenosis; renal resistive index