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Abstract
Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) constitute a high-risk phenotype with significant morbidity and mortality and poor prognosis. Multiple proinflammatory comorbid conditions influence the pathogenesis of HFpEF and CKD. Renal dysfunction in HFpEF is a consequence of the complex interplay between hemodynamic factors, systemic congestion, inflammation, endothelial dysfunction, and neurohormonal mechanisms. In contrast to heart failure with reduced ejection fraction, there is a dearth of effective targeted therapies for HFpEF. Tailoring study design toward the different phenotypes and delving into their pathophysiology may be fruitful in development of effective phenotype-specific targeted pharmaceutical therapies.
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Affiliation(s)
- Manjula G Ananthram
- Department of Internal Medicine, Division of Cardiology, University of Maryland, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA.
| | - Stephen S Gottlieb
- Department of Internal Medicine, Division of Cardiology, University of Maryland, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA
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Prencipe MA, Fontana A, Di Giorgio C, Pellegrino AM, Mangiacotti A, Coppetti M, Aucella F. Renal Resistive Index of the Main Renal Arteries and Transmitral Flow in Hypertensive Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2700-2710. [PMID: 32703658 DOI: 10.1016/j.ultrasmedbio.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
In hypertensive patients, diastolic dysfunction is related to increased resistive index (RI) of parenchymal renal arteries. To determine the existence of a link between RI of the main renal arteries (RRI) and diastolic dysfunction, a group of 127 hypertensive patients, with glomerular filtration rates >50 mL/min (mean estimated glomerular filtration rate: 88.6 ± 15.2 mL/min) and no comorbidities, was studied. RRI and transmitral flow were evaluated using the deceleration time (DT) and E/A ratio. A statistically significant correlation between RRI and DT (>240 ms) was noted (p < 0.001). The RRI cutoff that best discriminated patients with DT >240 ms was 0.675. For each unitary increment of 10 mm in DT, the log-transformed RRI significantly increased by a mean of 0.006 point (p < 0.001). This study revealed the importance of the link between RRI and transmitral DT in addition to the renowned significance of the increase in RI as a cardiovascular risk factor in hypertensive patients without comorbidities.
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Affiliation(s)
- Michele Antonio Prencipe
- Department of Medical Sciences, Division of Nephrology and Dialysis, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Chiara Di Giorgio
- Press Office, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Angela Maria Pellegrino
- Department of Medical Sciences, Division of Nephrology and Dialysis, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonio Mangiacotti
- Department of Medical Sciences, Division of Nephrology and Dialysis, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Massimiliano Coppetti
- Unit of Biostatistics, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Filippo Aucella
- Department of Medical Sciences, Division of Nephrology and Dialysis, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
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Quisi A, Harbalıoğlu H, Özel MA, Alıcı G, Genç Ö, Kurt IH. The association between the renal resistive index and the myocardial performance index in the general population. Echocardiography 2020; 37:1399-1405. [PMID: 32777128 DOI: 10.1111/echo.14702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The renal resistive index (RRI) is the most described measure of renal hemodynamics. The myocardial performance index (MPI) is widely used to assess overall myocardial performance. In this study, we aimed to investigate the relationship between renal hemodynamics, assessed by the RRI, and cardiac functions, assessed by the MPI in the general population. METHODS This single-center, cross-sectional study included a total of 302 consecutive patients who presented to our outpatient cardiology clinic between October 2019 and February 2020. All patients underwent transthoracic echocardiography and renal Doppler ultrasonography. The study population was divided into two groups: low RRI group (RRI ≤ 0.7, n = 236) and high RRI group (RRI > 0.7, n = 66). RESULTS E/A ratio, left ventricular ejection fraction (LVEF), and the MPI were significantly higher in the high RRI group than in the low RRI group (61.3 ± 15.4 vs 55.3 ± 16.4, P = .010 for E velocity; 0.9 ± 0.3 vs 0.7 ± 0.2, P = .008 for E/A ratio; 57.7 ± 4.7 vs 53.2 ± 10.1, P = .029 for LVEF; 0.52 ± 0.1 vs 0.43 ± 0.1, P < .001 for the MPI). A stepwise linear regression analysis demonstrated that LVEF (β = .123, P = .026), E velocity (β = .221, P < .001), and the MPI (β = .392, P < .001) were independently associated with the RRI. CONCLUSION Left ventricular ejection fraction and intra-cardiac Doppler blood flow indices, including E velocity and the MPI, were significantly and independently associated with the RRI in the general population.
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Affiliation(s)
- Alaa Quisi
- Department of Cardiology, Medline Hospital Adana, Adana, Turkey
| | - Hazar Harbalıoğlu
- Department of Cardiology, Düzce Atatürk State Hospital, Düzce, Turkey
| | - Mehmet Ali Özel
- Department of Radiology, Düzce Atatürk State Hospital, Düzce, Turkey
| | - Gökhan Alıcı
- Department of Cardiology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Ömer Genç
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - Ibrahim Halil Kurt
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
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Associations between increased renal resistive index and cardiovascular events. J Med Ultrason (2001) 2015; 43:263-70. [PMID: 27033870 DOI: 10.1007/s10396-015-0680-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/01/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Chronic kidney disease is a risk factor for cardiovascular disease (CVD). Renal resistive index (RI) measured by Doppler ultrasonography is associated with renal impairment. We investigated the relationship between RI and cardiac function, and evaluated the utility of RI for predicting cardiac events in patients with CVD. METHODS AND RESULTS Renal Doppler ultrasonography and echocardiography were performed in a total of 452 patients with CVD. Correlations of RI with serum creatinine and estimated glomerular filtration rate (eGFR) were significant but not strong (r = 0.37, p < 0.001; r = -0.42, p < 0.001, respectively). RI correlated positively with age, left atrial volume index, left ventricular mass index, and early transmitral velocity to mitral annular early diastolic velocity (e') ratio (E/e'), and showed significant negative correlations with e' and diastolic blood pressure. Between two subgroups-112 patients hospitalized with cardiovascular events (Group A) and 200 age- and eGFR-matched controls (Group B)-RI was significantly higher in Group A than in Group B, although age and eGFR were similar. CONCLUSIONS RI reflects the impairment of intrarenal hemodynamics that cannot be adequately elucidated by eGFR alone. Assessment of renal RI may be useful in conjunction with prognostic estimates for patients with CVD.
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Kuznetsova T, Cauwenberghs N, Knez J, Thijs L, Liu YP, Gu YM, Staessen JA. Doppler indexes of left ventricular systolic and diastolic flow and central pulse pressure in relation to renal resistive index. Am J Hypertens 2015; 28:535-45. [PMID: 25241047 DOI: 10.1093/ajh/hpu185] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The cardio-renal interaction occurs via hemodynamic and humoral factors. Noninvasive assessment of renal hemodynamics is currently possible by assessment of renal resistive index (RRI) derived from intrarenal Doppler arterial waveforms as ((peak systolic velocity - end-diastolic velocity)/peak systolic velocity). Limited information is available regarding the relationship between RRI and cardiac hemodynamics. We investigated these associations in randomly recruited subjects from a general population. METHODS In 171 participants (48.5% women; mean age, 52.2 years), using pulsed wave Doppler, we measured RRI (mean, 0.60) and left ventricular outflow tract (LVOT) and transmitral (E and A) blood flow peak velocities and its velocity time integrals (VTI). Using carotid applanation tonometry, we measured central pulse pressure and arterial stiffness indexes such as augmentation pressure and carotid-femoral pulse wave velocity. RESULTS In stepwise regression analysis, RRI independently and significantly increased with female sex, age, body weight, brachial pulse pressure, and use of β-blockers, whereas it decreased with body height and mean arterial pressure. In multivariable-adjusted models with central pulse pressure and arterial stiffness indexes as the explanatory variables, we observed a significant and positive correlation of RRI only with central pulse pressure (P < 0.0001). Among the Doppler indexes of left ventricular blood flow, RRI was significantly and positively associated with LVOT and E peak velocities (P ≤ 0.012) and VTIs (P ≤ 0.010). CONCLUSIONS We demonstrated that in unselected subjects RRI was significantly associated with central pulse pressure and left ventricular systolic and diastolic Doppler blood flow indexes. Our findings imply that in addition to the anthropometric characteristics, cardiac hemodynamic factors influence the intrarenal arterial Doppler waveform patterns.
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Affiliation(s)
- Tatiana Kuznetsova
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium;
| | - Nicholas Cauwenberghs
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Judita Knez
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yan-Ping Liu
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yu-Mei Gu
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Epidemiology, University of Maastricht, Maastricht, The Netherlands
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Jasińska-Stroschein M, Owczarek J, Łuczak A, Orszulak-Michalak D. The beneficial impact of fasudil and sildenafil on monocrotaline-induced pulmonary hypertension in rats: a hemodynamic and biochemical study. Pharmacology 2013; 91:178-84. [PMID: 23428587 DOI: 10.1159/000346921] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/08/2013] [Indexed: 11/19/2022]
Abstract
Pulmonary arterial hypertension (PAH) still cannot be cured effectively, hence the search for novel treatments continues. The effects of sildenafil (25 mg/kg body weight) and fasudil (30 mg/kg body weight) given alone or in combination, on normalization of right ventricular pressure (RVP), right ventricle mass, as well as the levels of several biomarkers (HDL-C, BNP, VEGF-A), were assessed in a rat model of monocrotaline (MCT)-induced PAH. MCT (60 mg/kg body weight) induced clear PAH in male Wistar rats. After 21 days, a significant decrease in RVP accompanied by a reduction of right ventricular hypertrophy - a significant decrease in the right ventricle/left ventricle plus septum ratio - as a result of sildenafil or fasudil administration was assessed. The administration of fasudil and sildenafil alone or in combination caused a significant decrease in plasma BNP level as compared to MCT-treated rats. Fasudil alone or with sildenafil, but not sildenafil alone, significantly increased HDL-C level as compared to MCT-treated rats. Fasudil and sildenafil given alone or in combination caused a significant increase in plasma VEGF-A level as compared to rats exposed to MCT.
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Abstract
AIM To investigate the association between subclinical organ damage and abdominal aortic diameter in a large cohort of uncomplicated essential hypertensive patients. METHODS Subclinical markers of organ damage (i.e. left ventricular mass, carotid intima-media thickness and plaques, microalbuminuria and retinal changes) and abdominal aortic diameter (ultrasonography) were assessed in 2430 (mean age 53 ± 13 years) untreated and treated hypertensive patients included in the Evaluation of Target Organ Damage in Hypertension (ETODH) study. RESULTS In the whole study population, left ventricular mass index was the most important correlate (β = 0.418, P < 0.0001) of the absolute abdominal aortic diameter and, after age, (β = 0.268, P < 0.0001) of abdominal aortic diameter indexed to body surface area (abdominal aorta index, AAI). In a sex-based analysis, a stepwise increase in left ventricular mass index as well as in prevalence of left ventricular hypertrophy (LVH), carotid intima-media thickness and plaques occurred from the lower to the upper quartile of AAI in men, but not in women. No correlations were found between AAI and microalbuminuria or retinal changes. CONCLUSION Our findings support a sex-specific relation between abdominal aorta size and subclinical organ damage by showing that LVH in hypertensive men is an independent correlate for enlarged abdominal aorta. On the basis of these data, diagnostic protocols for detecting subclinical alterations in the abdominal aorta should be optimized.
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Lubas A, Zelichowski G, Próchnicka A, Wiśniewska M, Saracyn M, Wańkowicz Z. Renal vascular response to angiotensin II inhibition in intensive antihypertensive treatment of essential hypertension. Arch Med Sci 2010; 6:533-8. [PMID: 22371796 PMCID: PMC3284067 DOI: 10.5114/aoms.2010.14464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 03/21/2010] [Accepted: 04/02/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION High blood pressure (BP) leads to target organ damage. It is suggested that regression of early organ lesions is possible on condition of BP normalization. The study objective was to assess whether permanent reduction of BP to the recommended values modifies renal vascular response to acute angiotensin II inhibition in the Doppler captopril test (DCT) in patients with essential hypertension (EH). MATERIAL AND METHODS Twenty-nine persons (58 kidneys) were found eligible for the study: 18 patients with EH and 11 healthy volunteers constituting the control group. Glomerular filtration rate estimation (eGFR), 24-h ambulatory BP monitoring (ABPM) and DCT with evaluation of renal resistive index change (ΔRI) were performed before and after a 6-month period of intensive antihypertensive therapy (IAT). Additional ABPM was performed at the end of IAT. RESULTS The mean IAT period was 8.5 ±2.4 months. The mean 24-h values of systolic and diastolic BP in the EH group were significantly lower in the IAT period than at the beginning and at the end of the study. Significantly lower systolic and diastolic BP (p < 0.05) and improvement of renal function (eGFR 121 ±38 vs. 139 ±40 ml/min, p < 0.001) were found after IAT as compared to initial values. Before IAT, ΔRI was significantly lower in the EH group as compared to the controls, but no such differences were found after IAT. CONCLUSIONS In EH patients, intensive BP lowering to the recommended values was associated with improvement of renal function and normalisation of renal vascular response to acute angiotensin II inhibition.
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Affiliation(s)
- Arkadiusz Lubas
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
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Masugata H, Senda S, Goda F, Yamagami A, Okuyama H, Kohno T, Yukiiri K, Noma T, Hosomi N, Imai M, Kohno M. Influences of Hypertension and Diabetes on Normal Age-Related Changes in Left Ventricular Function as Assessed by Tissue Doppler Echocardiography. Clin Exp Hypertens 2009; 31:400-14. [DOI: 10.1080/10641960802668722] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased Central Venous Pressure Is Associated With Impaired Renal Function and Mortality in a Broad Spectrum of Patients With Cardiovascular Disease. J Am Coll Cardiol 2009; 53:582-588. [PMID: 19215832 DOI: 10.1016/j.jacc.2008.08.080] [Citation(s) in RCA: 645] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 08/12/2008] [Accepted: 08/18/2008] [Indexed: 12/23/2022]
Affiliation(s)
- Kevin Damman
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Vincent M van Deursen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hans L Hillege
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Cuspidi C, Valerio C, Negri F, Sala C, Masaidi M, Giudici V, Zanchetti A, Mancia G. Prevalence and correlates of multiple organ damage in referred treated hypertensives: data from the ETODH study. J Hum Hypertens 2008; 22:801-3. [DOI: 10.1038/jhh.2008.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Aizawa K, Hanaoka T, Kasai H, Kogashi K, Kumazaki S, Koyama J, Tsutsui H, Yazaki Y, Watanabe N, Kinoshita O, Ikeda U. Long-Term Vardenafil Therapy Improves Hemodynamics in Patients with Pulmonary Hypertension. Hypertens Res 2006; 29:123-8. [PMID: 16755146 DOI: 10.1291/hypres.29.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The phosphodiesterase-5 (PDE-5) inhibitor, sildenafil, has been reported to produce sustained pulmonary vasodilatation in patients with pulmonary hypertension (PH). Recently, vardenafil, a more potent and selective PDE-5 inhibitor than sildenafil, has been approved for the treatment of erectile dysfunction. However, the long-term effects of oral vardenafil in patients with PH are unknown. We studied five consecutive patients with PH; one with primary pulmonary hypertension, two with chronic pulmonary thromboembolism, one with Eisenmenger syndrome (ventricular septal defect) and one with secondary pulmonary hypertension after a ventricular septal defect closure operation. In an acute hemodynamic trial, vardenafil (5 mg) significantly decreased both the pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) with an increase in cardiac output. In a chronic hemodynamic trial, the maintenance dose of vardenafil (10 to 15 mg) for 3 months significantly decreased the PVR, but not the SVR, with a 20.7% reduction of the PVR/ SVR ratio. Plasma brain natriuretic peptide (BNP) levels were also significantly decreased after 3 months. This pilot study demonstrates that long-term oral vardenafil therapy may be a safe and effective treatment for patients with PH.
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Affiliation(s)
- Kazunori Aizawa
- Division of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
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