Çakal Beytullah, Özcan Özgür Ulaş, Omaygenç Mehmet Onur, Karaca İbrahim Oğuz, Kızılırmak Filiz, Gunes Haci Murat, Boztosun Bilal
Department of Cardiology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey.
J Ultrasound Med. 2021 Feb;40(2):321-330. doi: 10.1002/jum.15404. Epub 2020 Jul 23.
Worsening of renal function in a patient with acute decompensated heart failure is called cardiorenal syndrome (CRS) type 1. Recent studies have shown an association of persistent systemic venous congestion with renal dysfunction. This trial was set up to investigate the changes of renal Doppler parameters with diuretic therapy in patients with CRS type 1.
Cases of CRS type 1 were identified among patients hospitalized for decompensated heart failure. Serial measurements of the renal venous impedance index (VII) and arterial resistive index (ARI) were calculated by pulsed wave Doppler sonography.
A total of 30 patients who had creatinine improvement with diuresis (group 1) and 34 patients without any improvement (group 2) were analyzed. Patients in group 1 had higher median VII and ARI (VII, 0.86 versus 0.66; P < .001; ARI, 0.78 versus 0.65; P < .001) on admission. A high ARI on admission (odds ratio, 6.25; 95% confidence interval, 1.84-14.3; P = .003) predicted the improvement of serum creatinine levels with diuretic therapy independent of confounding factors in patients with CRS type 1.
Renal vascular Doppler parameters might offer guidance on the diagnostic and therapeutic strategies in prescribing decongestive therapy for decompensated heart failure.
急性失代偿性心力衰竭患者肾功能恶化被称为1型心肾综合征（CRS）。近期研究表明，持续性体循环静脉淤血与肾功能障碍有关。本试验旨在研究1型CRS患者利尿治疗后肾多普勒参数的变化。
在因失代偿性心力衰竭住院的患者中识别出1型CRS病例。通过脉冲波多普勒超声计算肾静脉阻抗指数（VII）和动脉阻力指数（ARI）的系列测量值。
共分析了30例利尿后肌酐改善的患者（1组）和34例无任何改善的患者（2组）。1组患者入院时的VII和ARI中位数较高（VII，0.86对0.66；P < .001；ARI，0.78对0.65；P < .001）。入院时高ARI（比值比，6.25；95%置信区间，1.84 - 14.3；P = .003）可预测1型CRS患者利尿治疗后血清肌酐水平的改善，且不受混杂因素影响。
肾血管多普勒参数可能为失代偿性心力衰竭患者开具去充血治疗的诊断和治疗策略提供指导。
