Renal Artery Stenosis in Patients With Chronic Heart Failure
Renal Artery Stenosis in Patients With Chronic Heart Failure
Aims To investigate the prognostic impact of atherosclerotic renovascular disease in patients with chronic heart failure.
Methods and 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.
Atherosclerotic renovascular disease is a common finding in patients with heart failure and its prevalence varies between 12% and 34% depending upon the population studied and the definition used. Renal artery stenosis (RAS) might be mechanistically involved in the genesis of heart failure and affect patient management and outcomes. It can induce renal ischaemia and activation of the renin–angiotensin–aldosterone system (RAAS), which in turn leads to water and sodium retention and worsening heart failure symptoms. RAS may cause adrenergenic hyperactivity and, in the presence of RAS, treatment with RAAS inhibitors can lead to a dramatic decline in renal function, limiting the use of the drugs. However, although the implications of RAS for RAAS inhibitor treatment in patients with heart failure are well known, there is limited evidence about its impact on prognosis. We designed this prospective single centre study to examine the prevalence of RAS in patients with chronic heart failure (CHF) and investigate its effect on prognosis.
Abstract and Introduction
Abstract
Aims To investigate the prognostic impact of atherosclerotic renovascular disease in patients with chronic heart failure.
Methods and 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.
Introduction
Atherosclerotic renovascular disease is a common finding in patients with heart failure and its prevalence varies between 12% and 34% depending upon the population studied and the definition used. Renal artery stenosis (RAS) might be mechanistically involved in the genesis of heart failure and affect patient management and outcomes. It can induce renal ischaemia and activation of the renin–angiotensin–aldosterone system (RAAS), which in turn leads to water and sodium retention and worsening heart failure symptoms. RAS may cause adrenergenic hyperactivity and, in the presence of RAS, treatment with RAAS inhibitors can lead to a dramatic decline in renal function, limiting the use of the drugs. However, although the implications of RAS for RAAS inhibitor treatment in patients with heart failure are well known, there is limited evidence about its impact on prognosis. We designed this prospective single centre study to examine the prevalence of RAS in patients with chronic heart failure (CHF) and investigate its effect on prognosis.
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