Changes in Doppler‐Derived Kidney Venous Flow and Adverse Cardiorenal Outcomes in Patients With Heart Failure

Figures

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  Figure 1. Doppler at baseline (Doppler 1) kidney venous flow results. Each bar segment shows the proportion of intrakidney venous flow (IKVF) patterns (in bold) and the median kidney venous stasis index (KVSI) (interquartile range) at Doppler 1 for the entire population (first bar segment) and across the left ventricular ejection fraction categories of heart failure (HF) (second to fourth bar segments). HFmrEF indicates HF with midrange ejection fraction; HFpEF, HF with preserved ejection fraction; and HFrEF, HF with reduced ejection fraction.

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  Figure 2. Relationship between Doppler at baseline (Doppler 1) kidney venous stasis index (KVSI) and patient characteristics. The plots illustrate the relationship between Doppler 1 KVSI levels and key baseline continuous patient characteristics using linear regression models with restricted cubic splines. For each plot, the x axis is the independent variable, and the y axis displays the change in KVSI when compared with the KVSI at the median value of the variable. The solid line is the overall estimated effect, and the dashed lines are 95% confidence bands. P values for overall association are reported. Additional plots of other continuous baseline patient characteristics are provided in Figures S3 and S4. BNP indicates B‐type natriuretic peptide; eGFR, estimated glomerular filtration rate; NYHA, New York Heart Association; and TAPSE/SPAP, tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure.

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  Figure 3. Cumulative incidence for different Doppler at baseline kidney venous stasis index (KVSI) tertiles and intrakidney venous flow (IKVF) patterns. Cumulative incidence curves of the composite outcome (worsening heart failure or death) for KVSI tertiles/KVSI=0 (A) and IKVF patterns (B). In A, the red, yellow, green, and blue lines indicate the KVSI=0 group, and first, second, and third tertile groups, respectively. In B, the groups indicate patients with continuous (red line), pulsatile (yellow line), biphasic (green line), and monophasic (blue line) flow patterns.

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  Figure 4. Heart failure (HF) and kidney venous congestion continuum. The conceptual relationship between HF and Doppler‐derived kidney venous flow. Given the observed clinical characteristics seen across the spectrum of kidney venous congestion in patients with HF, there appears to be a cardiorenal disease continuum associated with decline in kidney function, activation of the neurohormonal system, volume overload, and worsening HF. BNP indicates B‐type natriuretic peptide; E/e', mitral inflow velocity/lateral annular relaxation velocity ratio; GFR, glomerular filtration rate; IKVF, intrakidney venous flow; IVC, inferior vena cava; KVSI, kidney venous stasis index; LA, left atrial; PAWP, pulmonary arterial wedge pressure; RA, right atrial; RAP, RA pressure; RFG, renal filtration gradient; RRI, renal resistive index; SO2, oxygen saturation; and TAPSE, tricuspid annular plane systolic excursion.