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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/24847

Title: Intrarenal Flow Alterations During Transition From Euvolemia to Intravascular Volume Expansion in Heart Failure Patients
Authors: Nijst, Petra
Martens, Pieter
Dupont, Matthias
Tang, W. H. Wilson
Mullens, Wilfried
Issue Date: 2017
Citation: JACC-HEART FAILURE, 5(9), p. 672-681
Abstract: OBJECTIVES The goal of this study was to assess: 1) the intrarenal flow in heart failure (HF) patients during the transition from euvolemia to intravascular volume overload; and 2) the relationship between intrarenal flow and diuretic efficiency. BACKGROUND Intrarenal blood flow alterations may help to better understand impaired volume handling in HF. METHODS Resistance index (RI) and venous impedance index (VII) were assessed in 6 healthy subjects, 40 euvolemic HF patients with reduced ejection fraction (HFrEF), and 10 HF patients with preserved ejection fraction (HFpEF). Assessments were performed by using Doppler ultrasonography at baseline, during 3 h of intravascular volume expansion with 1 l of hydroxyethyl starch 6%, and 1 h after the administration of a loop diuretic. Clinical parameters, echocardiography, and biochemistry were assessed. Urine output was collected after 3 and 24 h. RESULTS In response to volume expansion, VII increased significantly in HFrEF patients (0.4 +/- 0.3 to 0.7 +/- 0.2; p < 0.001) and in HFpEF patients (0.4 +/- 0.3 to 0.7 +/- 0.2; p = 0.002) but not in healthy subjects (0.2 +/- 0.2 to 0.3 +/- 0.1; p = 0.622). This outcome was reversed after loop diuretic administration. In contrast, RI did not change significantly after volume expansion. Echocardiographic-estimated filling pressures did not change significantly. VII during volume expansion was significantly correlated with diuretic response in HF patients independent of baseline renal function (R-2 = 0.35; p < 0.001). CONCLUSIONS In HF patients, intravascular volume expansion resulted in significant blunting of venous flow before a significant increase in cardiac filling pressures could be demonstrated. The observed impaired renal venous flow is correlated with less diuretic efficiency. Intrarenal venous flow patterns may be of interest for evaluating renal congestion. (C) 2017 by the American College of Cardiology Foundation.
Notes: [Nijst, Petra; Martens, Pieter; Dupont, Matthias; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. [Nijst, Petra; Martens, Pieter] Hasselt Univ, Sch Med & Life Sci, Diepenbeek, Belgium. [Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH USA. [Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium.
URI: http://hdl.handle.net/1942/24847
DOI: 10.1016/j.jchf.2017.05.006
ISI #: 000408585700009
ISSN: 2213-1779
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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