Key result
Renal artery stenosis was associated with higher rates of increased cardiac volume (68% vs 11%) and abnormal ECGs (58% vs 5%) compared to normotensive controls.
Why the study?
Do patients with renal artery stenosis exhibit worse preoperative haemodynamic parameters and cardiac abnormalities compared to normotensive patients undergoing major vascular surgery?
Case-Control (n=38)
Do patients with renal artery stenosis exhibit worse preoperative haemodynamic parameters and cardiac abnormalities compared to normotensive patients undergoing major vascular surgery?
Patients with renal artery stenosis exhibit significant preoperative haemodynamic alterations and signs of heart failure, warranting thorough preoperative haemodynamic evaluation.
RAS-associated cardiac changes may warrant preoperative caution in vascular surgery; leaves open causal impact and need for prospective outcome trials.
The ECG, chest x-ray and haemodynamic parameters were investigated preoperatively in 19 patients subjected to surgery for renal artery stenosis (RAS) and in a control group comprising 19 normotensive patients subjected to other forms of major vascular surgery. Increased cardiac volume was demonstrated in 13 (68%) RAS patients and in two (11%) patients from the control group. Abnormal ECG (i.e. left ventricular hypertrophy or atrial fibrillation) was observed in 11 (58%) RAS patients and in one (5%) patient from the control group. In the RAS patients the following haemodynamic parameters were found to be statistically significantly increased, compared to the control group: systemic blood pressure, (systolic arterial pressure: +43%, diastolic arterial pressure: +38%, mean arterial pressure: +41%), pulmonary artery mean pressure (+64%), pulmonary capillary wedge pressure (+107%), heart rate (+15%), systemic vascular resistance (+27%), left ventricular minute work index (+46%) and right ventricular minute work index (+67%). The presence of increased cardiac volume and abnormal ECG were more closely related to the level of the pathologically increased pulmonary artery mean and wedge pressures than to the systemic blood pressure or central venous pressure. A preoperative haemodynamic evaluation is recommended to determine the degree of heart failure in RAS patients with: left ventricular hypertrophy and increased cardiac volume, or atrial fibrillation.
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Sørensen et al. (1984) conducted a case-control in Renal artery stenosis (n=38). Renal artery stenosis vs. Normotensive patients undergoing other major vascular surgery was evaluated on Increased cardiac volume. Renal artery stenosis was associated with higher rates of increased cardiac volume (68% vs 11%) and abnormal ECGs (58% vs 5%) compared to normotensive controls.
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