Cardiovascular complications according to severity of renal artery stenosis based on Doppler ultrasound

Abstract

IntroductionThe interactions between ARAS, independent on severity, and cardiovascular risk, and mortality are complex and not fully researched. The aim of this study was the assessment of the risk of cardiovascular events and mortality in patients with hemodynamically non-significant (NS-RAS) and significant renal artery stenosis (S-RAS) diagnosed with ultrasonography.Material and methodsThe study group consisted of all consecutive patients (n = 2,059) who underwent Doppler ultrasound of the renal arteries during a four years’ time. The patients were divided, according to the renal aortic ratio (RAR) into: hemodynamically significant RAS (S-RAS; RAR ≥ 3.5), hemodynamically non-significant RAS (NS-RAS; 1 < RAR < 3.5) and normal RAR (control group; RAR ≤ 1). The risk of cardiovascular events and death was estimated using Cox’s proportional hazard model including severity of RAS, age and gender, based on the data from the National Health Fund on causes of hospitalization, deaths and statistics on percutaneous coronary angioplasty procedures.ResultsS-RAS was found in 112 patients (5.4 %), NS-RAS in 313 patients (15.2 %) and 1634 patients (79.4 %) were qualified to control group. NS-RAS group had an increased risk of stroke (7.0 % vs. 3.0 %; HR 1.77; p = 0.032). S-RAS patients were at increased risk of heart failure (16.1 % vs. 5.2 %, HR 2.19; p = 0.002) and death (19.6 % vs. 4.3 %; HR 3.08; p < 0.001).ConclusionsThe presence of hemodynamically non-significant renal artery stenosis is an indicator of systemic atherosclerotic changes in vital organs and an important cardiovascular risk factor for stroke.

A new threshold for kidney asymmetry improves association with abnormal renal-aortic ratio for diagnosis of renal artery stenosis

“…14,15 The presence of even hemodynamically nonsignificant RAS is an indicator of systemic atherosclerotic changes in vital organs and an important cardiovascular risk factor, especially for stroke. 12…”

“…Patients with RAS are characterized by high cardiovascular morbidity and mortality. [7][8][9][10][11][12][13] RAS is the leading cause of secondary hypertension and may result in resistant hypertension, unexplained, progressive renal failure, recurrent congestive heart failure, and flash pulmonary edema. 14,15 The presence of even hemodynamically nonsignificant RAS is an indicator of systemic atherosclerotic changes in vital organs and an important cardiovascular risk factor, especially for stroke.…”

“…14,15 The presence of even hemodynamically nonsignificant RAS is an indicator of systemic atherosclerotic changes in vital organs and an important cardiovascular risk factor, especially for stroke. 12 The prevalence of RAS ranges between 10% and 40% in patients with severe or refractory hypertension. 16,17 RAS is often suspected for the first time when there is kidney asymmetry on imaging studies.…”