Lower Systolic Blood Pressure and Cardiovascular Event Risk Stratified by Renal Resistive Index in Hospitalized Cardiovascular Patients: J-VAS Study

In essential hypertension, a change in the renal resistive index is associated with a change in the ratio of 24-hour diastolic to systolic blood pressure

An increase in the renal resistive index (RRI) in patients with essential hypertension (EH) predicts deterioration in renal function. In patients with EH, changes in hemodynamic parameters significantly affect the RRI. This study aimed to define changes in Ambulatory Blood Pressure Monitoring (ABPM) parameters that are significantly associated with a change in RRI in patients with EH. We evaluated ABPM and the RRI in 96 patients with EH without organ extrarenal changes at baseline and after two years of follow-up. The relationships between changes in ABPM parameters and the RRI over the period were evaluated. After two years of follow-up, the increase in RRI was consequential. Simultaneously, 24-h systolic blood pressure increased significantly and 24-h diastolic blood pressure decreased. In the whole group and in the group with calculated cystatin C clearance (eGFRcyst) >/=90 ml/min/1.73 m2, the change in RRI significantly negatively correlated with the change in the ratio of 24-h diastolic to systolic blood pressure (D/S ratio), but also with the change in 24-h pulse blood pressure. However, in patients with eGFRcyst>90 ml/min/1.73 m2, only the change in the 24-h D/S ratio significantly correlated with the change in RRI. Based on the backward stepwise regression analysis, the change in RRI was significantly dependent only on the change in 24-h D/S ratio and not on the change in 24-h pulse pressure. A change in the ratio of diastolic to systolic pressure better reflects a change in RRI than a change in pulse pressure.

Differential Impact of the Renal Resistive Index on Future Cardiovascular Events in Hospitalized Atherosclerotic Cardiovascular Patients According to Left Ventricular Ejection Fraction - The Jichi Vascular Hemodynamics in Hospitalized Cardiovascular Patients (J-VAS) Study

BACKGROUND

Determinants of poor outcome in atherosclerotic cardiovascular disease (ASCVD) according to left ventricular ejection fraction (LVEF) are unclear. The renal resistive index (RRI) correlates well with atherosclerotic vascular damage, which, in turn, is correlated with cardiovascular outcomes. This study investigated whether high RRI is associated with poor cardiovascular outcomes in ASCVD patients classified by LVEF.

METHODS AND RESULTS

Records of 1,598 acute coronary syndromes (ACS) and acute decompensated heart failure (ADHF) patients, categorized into preserved (p), mid-range (mr), and reduced (r) ejection fraction (EF) groups (EF ≥50% [n=1,130], 40-50% [n=223], and <40% [n=245], respectively), were analyzed retrospectively. The primary endpoint was any cardiovascular-related event: fatal and non-fatal ACS, ADHF, stroke, and sudden cardiac death. Over 1.9-years follow-up (3,030 person-years), 233 events occurred: 122, 37, and 74 in the pEF, mrEF, and rEF groups, respectively. Adjusted Cox regression analysis revealed RRI ≥0.8 was associated with the primary endpoint in the pEF group (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.09-2.56), but not in the mrEF or rEF groups. The primary endpoint risk of pEF patients with an RRI ≥0.8 was comparable to that of mrEF patients using the pEF+RRI <0.8 group as the reference (HR 1.89 [95% CI 1.26-2.83] and 1.77 [95% CI 1.19-2.63], respectively).

CONCLUSIONS

RRI was associated with the risk of cardiovascular events in ASCVD patients with pEF.