Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy.
Department of Pathology, Cardiology Division, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
Medicina (Kaunas). 2023 Sep 24;59(10):1704. doi: 10.3390/medicina59101704.
: We evaluated the bio-humoral and non-invasive haemodynamic correlates of renal congestion evaluated by Doppler renal venous flow (RVF) across the heart failure (HF) spectrum, from asymptomatic subjects with cardiovascular risk factors (Stage A) and structural heart disease (Stage B) to patients with clinically overt HF (Stage C). : Ultrasound evaluation, including echocardiography, lung ultrasound and RVF, along with blood and urine sampling, was performed in 304 patients. : Continuous RVF was observed in 230 patients (76%), while discontinuous RVF (dRVF) was observed in 74 (24%): 39 patients had pulsatile RVF, 18 had biphasic RVF and 17 had monophasic RVF. Stage C HF was significantly more common among patients with dRVF. Monophasic RVF was associated with worse renal function and a higher urinary albumin-to-creatinine ratio (uACR). After adjusting for hypertension, diabetes mellitus, the presence of Stage C HF and serum creatinine levels, worsening RVF patterns were associated with higher NT-proBNP levels, worse right ventricular-arterial coupling, larger inferior vena cava and higher echo-derived pulmonary artery wedge pressure. This trend was confirmed when only patients with HF Stage C were analysed after adjusting for the left ventricle ejection fraction (LVEF). : Abnormal RVF is common across the HF spectrum. Worsening RVF patterns are independently associated with increased congestion, worse non-invasive haemodynamics and impaired RV-arterial coupling. RVF evaluation could refine prognostic stratification across the HF spectrum, irrespective of LVEF.
我们评估了多普勒肾静脉血流（RVF）评估的肾功能不全的生物-体液和非侵入性血流动力学相关性，跨越心力衰竭（HF）谱，从心血管危险因素（A 期）和结构性心脏病（B 期）的无症状患者到有临床明显 HF（C 期）的患者。
在 304 名患者中进行了超声评估，包括超声心动图、肺部超声和 RVF 以及血液和尿液采样。
在 230 名患者（76%）中观察到连续 RVF，而在 74 名患者（24%）中观察到间断 RVF：39 名患者有搏动性 RVF，18 名患者有双相 RVF，17 名患者有单相 RVF。C 期 HF 在具有间断 RVF 的患者中更为常见。单相 RVF 与肾功能更差和尿白蛋白/肌酐比（uACR）更高相关。在调整高血压、糖尿病、C 期 HF 的存在和血清肌酐水平后，RVF 模式恶化与更高的 NT-proBNP 水平、更差的右心室-动脉偶联、更大的下腔静脉和更高的超声衍生肺动脉楔压相关。当仅在调整左心室射血分数（LVEF）后分析 C 期 HF 患者时，证实了这一趋势。
异常 RVF 在 HF 谱中很常见。RVF 模式恶化与充血增加、非侵入性血流动力学恶化和 RV-动脉偶联受损独立相关。RVF 评估可改善 HF 谱中的预后分层，而与 LVEF 无关。
