Doppler‐Derived Renal Venous Stasis Index in the Prognosis of Right Heart Failure

Husain‐Syed, Faeq; Birk, Horst‐Walter; Ronco, Claudio; Schörmann, Tanja; Tello, Khodr; Richter, Manuel J.; Wilhelm, Jochen; Sommer, Natascha; Steyerberg, Ewout W.; Bauer, Pascal; Walmrath, Hans‐Dieter; Seeger, Werner; McCullough, Peter A.; Gall, Henning; Ghofrani, HA

doi:10.1161/jaha.119.013584

Cited by 79 publications

(111 citation statements)

References 35 publications

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“…Our results con rm the role of RRI and RVF in predicting occurrence of AKI. The RRI evaluation has gained importance in last years to monitor renal perfusion and to predict the occurrence of AKI, [11][12][13]22] as well as its severity. [23] Indeed, the genesis of kidney injury includes intrarenal vasoconstriction and endothelial damage of the micro-vessels which lead to impaired macro-and microvascular ow, both causes of increased RRI.…”

Section: Discussionmentioning

confidence: 99%

“…[23] Indeed, the genesis of kidney injury includes intrarenal vasoconstriction and endothelial damage of the micro-vessels which lead to impaired macro-and microvascular ow, both causes of increased RRI. [22,23] On the other hand, the RVF pattern is able to identify the occurrence of glomerular congestion, which is an additional cause of renal blood ow impairment [11]. High RRI values have been associated with the need for vasopressor support, hypotension and lactate levels [12],…”

Section: Discussionmentioning

confidence: 99%

“…An RRI >0.7 was deemed pathological. [11][12][13] The RVF pattern was classi ed as continuous, biphasic or monophasic. [11] Under physiological conditions, the RVF pattern is continuous, whereas during renal congestion it becomes biphasic or even monophasic.…”

Section: Mechanical Ventilation Settingsmentioning

confidence: 99%

“…[11][12][13] The RVF pattern was classi ed as continuous, biphasic or monophasic. [11] Under physiological conditions, the RVF pattern is continuous, whereas during renal congestion it becomes biphasic or even monophasic. [11] For both RRI and RVF three measurements were obtained over 3 cardiac cycles and the mean value was recorded for analysis.…”

Section: Mechanical Ventilation Settingsmentioning

confidence: 99%

“…Hence the aim of our study was to document a potential different involvement of the kidney function by evaluating the degree of renal blood ow impairment in SARS-COV-2 ARDS compared to those with the "classic" ARDS. Accordingly, we performed an ultrasound evaluation of the renal resistivity index (RRI) and renal venous ow pattern (RVF) [11][12][13] in two groups of patients, i.e. with SARS-COV-2 ARDS and with ARDS, ventilated with the same lung-protective protocol.…”

Section: Introductionmentioning

confidence: 99%

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Focus on renal blood flow in mechanically ventilated patients with SARS-CoV-2

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Dres³

et al. 2020

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Background: Patients with ARDS due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) seem particularly susceptible to AKI. Our hypothesis was that the renal blood flow could be more compromised in SARS-CoV-2 patients than in patients with “traditional” ARDS. We compared the renal resistivity index (RRI) and the renal venous flow (RVF) in ARDS patients with SARS-CoV-2 and in ARDS patients due to other etiologies.Materials and Methods: Prospective, observational study performed on 30 mechanically ventilated patients (15 with SARS-COV-2 ARDS and 15 with ARDS). Ultrasound Doppler measurements of RRI and RVF pattern were performed in each patient.Results: Patients with SARS-COV-2 ARDS had higher RRI than patients with ARDS (0.71[0.67–0.78] vs 0.64[0.60–0.74], p=0.04). RVF was not-continuous in 9/15 patients (71%) in the SARS-COV-2 ARDS group and in and 5/15 (33%) in the ARDS group (p=0.27). A linear correlation was found between PEEP and RRI in patients with SARS-COV-2 ARDS (r2=0.31; p=0.03) but not in patients with ARDS. Occurrence of AKI was 53% in patients with SARS-COV-2 ARDS and 33% in patients with ARDS (p=0.46).Conclusions: We found a more pronounced impairment in renal blood flow in mechanically ventilated patients with SARS-COV-2 ARDS, compared with patients with “traditional” ARDS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Mechanical Ventilation Settingsmentioning

confidence: 99%

Section: Mechanical Ventilation Settingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Focus on renal blood flow in mechanically ventilated patients with SARS-CoV-2

Fogagnolo

Grasso

Dres³

et al. 2020

Preprint

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Venous congestion assessment using point‐of‐care Doppler ultrasound: Welcome to the future of volume status assessment

Koratala

2021

Clinical Case Reports

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Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure

et al. 2020

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Aims Venous congestion is a major determinant of worsening renal function (WRF) in acute decompensated heart failure (ADHF), particularly when associated with right ventricular (RV) dysfunction. Whether the individual impacts of hemodynamic variables on renal outcomes in ADHF is modified according to RV function remains unclear. We aimed to determine the association between hemodynamic parameters and early changes in renal function during depletive therapy and explore the association of these changes with clinical outcomes. Methods and results WRF was defined as any increase in creatinine after 24 h of depletive therapy and improvement in renal function (IRF) as any decrease. Assessments were prospectively obtained on admission, 24 h later and at discharge. Out of the 105 patients enrolled, 45% had IRF, and 41% had poor RV. At baseline, patients evolving towards IRF had a lower mean arterial pressure (84.7 ± 13.9 vs. 90.9 ± 15.2 mmHg), a lower renal perfusion pressure (69.4 ± 16.2 vs. 75.4 ± 15.1 mmHg), and a poorer RV function (tricuspid annular plan systolic excursion 16.5 ± 6.0 vs. 18.8 ± 5.6 mm) in comparison with those with WRF (all P < 0.05). In a multivariate linear regression model, tricuspid annular plane systolic excursion was the dominant parameter correlated with early changes in creatinine when RV was poor (β = 0.337), whereas mean arterial pressure (β = À0.334) and cardiac output (β = À0.298) were the only parameters correlated with renal function in patients with preserved RV function (all P < 0.05). RV dysfunction, but not early changes in renal function, was associated with post-discharge clinical events. Conclusions RV dysfunction is a predictor of an early but transient progression to IRF during depletive therapy. RV dysfunction modifies the individual impact of various hemodynamic variables on the early trajectory of renal function in ADHF.

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Doppler‐Derived Renal Venous Stasis Index in the Prognosis of Right Heart Failure

Cited by 79 publications

References 35 publications

Focus on renal blood flow in mechanically ventilated patients with SARS-CoV-2

Focus on renal blood flow in mechanically ventilated patients with SARS-CoV-2

Venous congestion assessment using point‐of‐care Doppler ultrasound: Welcome to the future of volume status assessment

Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure

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