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Open AccessArticle

Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients

Cardiology Unit, IRCCS istituto tumori “Giovanni Paolo II” di Bari, Italia
Emergency Cardiology Unit, University Policlinic Hospital, 70124 Bari, Italy
Cardiovascular Department, Scientific Clinical Institutes Maugeri, Institute of Cassano delle Murge, 70124 Bari, Italy
Cardiology Unit, SS Annunziata Hospital, 74123 Taranto, Italy
School of Cardiology, University of Bari, 70124 Bari, Italy
University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy
Author to whom correspondence should be addressed.
J. Cardiovasc. Dev. Dis. 2018, 5(4), 52;
Received: 21 August 2018 / Revised: 29 October 2018 / Accepted: 30 October 2018 / Published: 3 November 2018
Aim of the study: In chronic heart failure (CHF) patients, renal congestion plays a key role in determining the progression of renal dysfunction and a worse prognosis. The aim of this study was to define the role of Doppler venous patterns reflecting renal congestion that predict heart failure progression. Methods: We enrolled outpatients affected by CHF, in stable clinical conditions and in conventional therapy. All patients underwent a clinical evaluation, routine chemistry, an echocardiogram and a renal echo-Doppler. Pulsed Doppler flow recording was performed at the level of interlobular renal right veins in the tele-expiratory phase. The venous flow patterns were divided into five groups according to the fluctuations of the flow. Type A and B were characterized by a continuous flow, whereas type C was characterized by a short interruption or reversal flow during the end-diastolic or protosystolic phase. Type D and E were characterized by a wide interruption and/or reversal flow. The occurrence of death and/or of heart transplantation and/or of hospitalization due to heart failure worsening was considered an event during follow-up. Results: During a median follow-up of 38 months, 126 patients experienced the considered end-point. Venous pattern C (HR 4.04; 95% CI: 2.14–7.65; p < 0.001), pattern D (HR 7.16; 95% CI: 3.69–13.9; p < 0.001) and pattern E (HR 8.94; 95% CI: 4.65–17.2; p < 0.001) were all associated with events using an univariate Cox regression analysis. Moreover, both the presence of pattern C (HR: 1.79; 95% CI: 1.09–2.97; p: 0) and of pattern D or E (HR: 1.90; 95% CI: 1.16–3.12; p: 0.011) remained significantly associated to events using a multivariate Cox regression analysis after correction for a reference model with an improvement of the overall net reclassification index (0.46; 95% CI 0.24–0.68; p < 0.001). Conclusions: Our findings demonstrate the independent and incremental role of Doppler venous patterns reflecting renal congestion in predicting HF progression among CHF patients, thus suggesting its possible utility in daily clinical practice to better characterize patients with cardio-renal syndrome. View Full-Text
Keywords: cardiorenal syndrome; prognosis; heart failure; renal Doppler; congestion cardiorenal syndrome; prognosis; heart failure; renal Doppler; congestion
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Puzzovivo, A.; Monitillo, F.; Guida, P.; Leone, M.; Rizzo, C.; Grande, D.; Ciccone, M.M.; Iacoviello, M. Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients. J. Cardiovasc. Dev. Dis. 2018, 5, 52.

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