Key result
A high renal resistive index (≥0.70) was associated with a higher incidence of cardiovascular events requiring unscheduled hospitalization in adults with CHD (HR 2.78; 95% CI 1.26-6.10; P<0.05).
Why the study?
Do elevated central venous pressure and abnormal intrarenal flow dynamics predict cardiovascular events in adults with congenital heart disease after biventricular repair?
Cohort (n=107)
Do elevated central venous pressure and abnormal intrarenal flow dynamics predict cardiovascular events in adults with congenital heart disease after biventricular repair?
Hazard Ratio: 2.78 (95% CI 1.26–6.1)
p-value: p=<.05
High central venous pressure is associated with enlarged kidneys and abnormal intrarenal flow dynamics, which independently predict cardiovascular events in adults with congenital heart disease after biventricular repair.
High CVP may signal cardiorenal risk and events in repaired adult CHD; leaves open whether targeted venous decompression improves outcomes.
BACKGROUND: Cardiorenal interactions adversely impact the prognosis in heart failure patients an effect which crucially involves increased central venous pressure (CVP). However, it is unclear whether the same pathophysiology operates in adults with congenital heart disease (CHD). PURPOSE: The present study was designed to assess cardiorenal interactions in adults with CHD after biventricular repair. METHODS AND RESULTS: We measured the kidney length (KL, cm/m) and renal resistive index (RI) in 77 consecutive patients and 30 controls. We also measured hemodynamics, plasma B-type natriuretic peptide level, 24-hour creatinine clearance, and peak oxygen uptake in each patient. The CVP correlated with the KL (r = 0.44, P <.001) and the RI was greater in the patients (P <.0001). The high RI was independently determined by the CVP, aortic pressure, and cardiac index (P <.05-.001), and correlated with the 24-hour creatinine clearance (r = -0.30, P <.05). The RI correlated closely with the neurohumoral activations and peak oxygen uptake (|r| = 0.45-0.50, P <.0001), and the patients with a traditional criteria of high RI (≥0.70) had a higher incidence of cardiovascular events that required unscheduled hospitalization (hazard ratio = 2.78, 95% confidence interval 1.26-6.10, P <.05). Multivariate Cox model with the cutoff values of KL ≥68 cm/m and RI ≥0.74 revealed that a greater KL (hazard ratio = 4.03, 95% confidence interval 1.46-11.1, P <.01) as well as B-type natriuretic peptide (P <.001) independently predicted the events. CONCLUSIONS: Hemodynamics, especially a high CVP, independently predicted the enlarged kidney and abnormal intrarenal flow dynamics that are closely associated with heart failure severity and cardiovascular events in adults with CHD after biventricular repair.
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Ohuchi et al. (2012) conducted a cohort in Congenital heart disease after biventricular repair (n=107). High renal resistive index (≥0.70) vs. Renal resistive index <0.70 was evaluated on Cardiovascular events requiring unscheduled hospitalization (HR 2.78, 95% CI 1.26-6.10, p=<.05). A high renal resistive index (≥0.70) was associated with a higher incidence of cardiovascular events requiring unscheduled hospitalization in adults with CHD (HR 2.78; 95% CI 1.26-6.10; P<0.05).
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