Cardiac function response to stenting in atherosclerotic renal artery disease with and without heart failure: results from the Carmel study

Osami Kawarada, Teruyoshi Kume, Kan Zen, Shigeru Nakamura, Koji Hozawa, Tadafumi Akimitsu, Hiroshi Asano, Hiroshi Ando, Yoshito Yamamoto, Takehiro Yamashita, Norihiko Shinozaki, Keita Odashiro, Tadaya Sato, Kenichiro Yuba, Yuji Sakanoue, Takashi Uzu, Kozo Okada, Peter J. Fitzgerald, Yasuhiro Honda, Satoshi Yasuda

Research output: Contribution to journalArticle

Abstract

Aims: Consensus-derived guidelines recommend renal stenting for patients with atherosclerotic renal artery disease (ARAD) and heart failure (HF). The aim of this prospective multi-centre observational study was to verify our hypothesis that changes in E/e′, an echocardiographic correlate of left ventricular (LV) filling pressure, following renal stenting may differ between ARAD patients with and without HF. Methods and results: This study enrolled de novo ARAD patients undergoing renal stenting at 14 institutions. The primary endpoint was the difference in E/e′ change between ARAD patients with and without HF. Clinical and echocardiographic data were prospectively collected at baseline, the day following renal stenting, and 1 month and 6 months afterwards. ARAD patients with HF were defined as patients with New York Heart Association (NYHA) Class 2 and more, or a history of HF hospitalization. A total of 76 patients were included, and 39% were ARAD patients with HF. ARAD patients with HF had significantly lower estimated glomerular filtration rate (P = 0.028) and higher NYHA functional class (P < 0.001) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (P = 0.001) than ARAD patients without HF. Also, ARAD patients with HF had significantly lower LV ejection fraction (P = 0.003) and e′-velocity (P = 0.003) and higher E/e′ ratio (P = 0.001), left atrial volume index (LAVI) (P = 0.046), LV end-diastolic volume (LVEDV) (P = 0.001), LV end-systolic volume (LVESV) (P = 0.001), and LV mass index (P = 0.009) than ARAD patients without HF. All procedures were successful. In contrast to blood pressure and renal function, there was a significant interaction in E/e′ (Pinteraction < 0.001) between time and HF, and ARAD patients with HF showed a significant (P < 0.001) decrease in E/e′ albeit those without HF. By the same token, there was a significant interaction in NYHA class (Pinteraction < 0.001), MLHFQ score (Pinteraction = 0.018), E-velocity (Pinteraction = 0.002), LAVI (Pinteraction = 0.001), LVEDV (Pinteraction = 0.003), and LVESV (Pinteraction = 0.001) between time and HF with a significant improvement in all these variables in ARAD patients with HF (NYHA class, P = 0.001; MLHFQ score, P = 0.002; E-velocity, P = 0.005; LAVI, P = 0.001; LVEDV, P = 0.017; and LVESV, P = 0.011). Conclusions: Change in LV filling pressure after renal stenting differed between ARAD patients with and without HF, with a significant improvement in LV filling pressure in patients with HF-ARAD. These unique findings might support clinical cardiac benefits of renal artery stenting in ARAD patients with HF.

Original languageEnglish
JournalESC heart failure
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Renal Artery
Heart Failure
Kidney
Ventricular Pressure
Stroke Volume

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac function response to stenting in atherosclerotic renal artery disease with and without heart failure : results from the Carmel study. / Kawarada, Osami; Kume, Teruyoshi; Zen, Kan; Nakamura, Shigeru; Hozawa, Koji; Akimitsu, Tadafumi; Asano, Hiroshi; Ando, Hiroshi; Yamamoto, Yoshito; Yamashita, Takehiro; Shinozaki, Norihiko; Odashiro, Keita; Sato, Tadaya; Yuba, Kenichiro; Sakanoue, Yuji; Uzu, Takashi; Okada, Kozo; Fitzgerald, Peter J.; Honda, Yasuhiro; Yasuda, Satoshi.

In: ESC heart failure, 01.01.2019.

Research output: Contribution to journalArticle

Kawarada, O, Kume, T, Zen, K, Nakamura, S, Hozawa, K, Akimitsu, T, Asano, H, Ando, H, Yamamoto, Y, Yamashita, T, Shinozaki, N, Odashiro, K, Sato, T, Yuba, K, Sakanoue, Y, Uzu, T, Okada, K, Fitzgerald, PJ, Honda, Y & Yasuda, S 2019, 'Cardiac function response to stenting in atherosclerotic renal artery disease with and without heart failure: results from the Carmel study' ESC heart failure. https://doi.org/10.1002/ehf2.12391
Kawarada, Osami ; Kume, Teruyoshi ; Zen, Kan ; Nakamura, Shigeru ; Hozawa, Koji ; Akimitsu, Tadafumi ; Asano, Hiroshi ; Ando, Hiroshi ; Yamamoto, Yoshito ; Yamashita, Takehiro ; Shinozaki, Norihiko ; Odashiro, Keita ; Sato, Tadaya ; Yuba, Kenichiro ; Sakanoue, Yuji ; Uzu, Takashi ; Okada, Kozo ; Fitzgerald, Peter J. ; Honda, Yasuhiro ; Yasuda, Satoshi. / Cardiac function response to stenting in atherosclerotic renal artery disease with and without heart failure : results from the Carmel study. In: ESC heart failure. 2019.
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title = "Cardiac function response to stenting in atherosclerotic renal artery disease with and without heart failure: results from the Carmel study",
abstract = "Aims: Consensus-derived guidelines recommend renal stenting for patients with atherosclerotic renal artery disease (ARAD) and heart failure (HF). The aim of this prospective multi-centre observational study was to verify our hypothesis that changes in E/e′, an echocardiographic correlate of left ventricular (LV) filling pressure, following renal stenting may differ between ARAD patients with and without HF. Methods and results: This study enrolled de novo ARAD patients undergoing renal stenting at 14 institutions. The primary endpoint was the difference in E/e′ change between ARAD patients with and without HF. Clinical and echocardiographic data were prospectively collected at baseline, the day following renal stenting, and 1 month and 6 months afterwards. ARAD patients with HF were defined as patients with New York Heart Association (NYHA) Class 2 and more, or a history of HF hospitalization. A total of 76 patients were included, and 39{\%} were ARAD patients with HF. ARAD patients with HF had significantly lower estimated glomerular filtration rate (P = 0.028) and higher NYHA functional class (P < 0.001) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (P = 0.001) than ARAD patients without HF. Also, ARAD patients with HF had significantly lower LV ejection fraction (P = 0.003) and e′-velocity (P = 0.003) and higher E/e′ ratio (P = 0.001), left atrial volume index (LAVI) (P = 0.046), LV end-diastolic volume (LVEDV) (P = 0.001), LV end-systolic volume (LVESV) (P = 0.001), and LV mass index (P = 0.009) than ARAD patients without HF. All procedures were successful. In contrast to blood pressure and renal function, there was a significant interaction in E/e′ (Pinteraction < 0.001) between time and HF, and ARAD patients with HF showed a significant (P < 0.001) decrease in E/e′ albeit those without HF. By the same token, there was a significant interaction in NYHA class (Pinteraction < 0.001), MLHFQ score (Pinteraction = 0.018), E-velocity (Pinteraction = 0.002), LAVI (Pinteraction = 0.001), LVEDV (Pinteraction = 0.003), and LVESV (Pinteraction = 0.001) between time and HF with a significant improvement in all these variables in ARAD patients with HF (NYHA class, P = 0.001; MLHFQ score, P = 0.002; E-velocity, P = 0.005; LAVI, P = 0.001; LVEDV, P = 0.017; and LVESV, P = 0.011). Conclusions: Change in LV filling pressure after renal stenting differed between ARAD patients with and without HF, with a significant improvement in LV filling pressure in patients with HF-ARAD. These unique findings might support clinical cardiac benefits of renal artery stenting in ARAD patients with HF.",
author = "Osami Kawarada and Teruyoshi Kume and Kan Zen and Shigeru Nakamura and Koji Hozawa and Tadafumi Akimitsu and Hiroshi Asano and Hiroshi Ando and Yoshito Yamamoto and Takehiro Yamashita and Norihiko Shinozaki and Keita Odashiro and Tadaya Sato and Kenichiro Yuba and Yuji Sakanoue and Takashi Uzu and Kozo Okada and Fitzgerald, {Peter J.} and Yasuhiro Honda and Satoshi Yasuda",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/ehf2.12391",
language = "English",
journal = "ESC heart failure",
issn = "2055-5822",
publisher = "The Heart Failure Association of the European Society of Cardiology",

}

TY - JOUR

T1 - Cardiac function response to stenting in atherosclerotic renal artery disease with and without heart failure

T2 - ESC heart failure

AU - Kawarada, Osami

AU - Kume, Teruyoshi

AU - Zen, Kan

AU - Nakamura, Shigeru

AU - Hozawa, Koji

AU - Akimitsu, Tadafumi

AU - Asano, Hiroshi

AU - Ando, Hiroshi

AU - Yamamoto, Yoshito

AU - Yamashita, Takehiro

AU - Shinozaki, Norihiko

AU - Odashiro, Keita

AU - Sato, Tadaya

AU - Yuba, Kenichiro

AU - Sakanoue, Yuji

AU - Uzu, Takashi

AU - Okada, Kozo

AU - Fitzgerald, Peter J.

AU - Honda, Yasuhiro

AU - Yasuda, Satoshi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: Consensus-derived guidelines recommend renal stenting for patients with atherosclerotic renal artery disease (ARAD) and heart failure (HF). The aim of this prospective multi-centre observational study was to verify our hypothesis that changes in E/e′, an echocardiographic correlate of left ventricular (LV) filling pressure, following renal stenting may differ between ARAD patients with and without HF. Methods and results: This study enrolled de novo ARAD patients undergoing renal stenting at 14 institutions. The primary endpoint was the difference in E/e′ change between ARAD patients with and without HF. Clinical and echocardiographic data were prospectively collected at baseline, the day following renal stenting, and 1 month and 6 months afterwards. ARAD patients with HF were defined as patients with New York Heart Association (NYHA) Class 2 and more, or a history of HF hospitalization. A total of 76 patients were included, and 39% were ARAD patients with HF. ARAD patients with HF had significantly lower estimated glomerular filtration rate (P = 0.028) and higher NYHA functional class (P < 0.001) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (P = 0.001) than ARAD patients without HF. Also, ARAD patients with HF had significantly lower LV ejection fraction (P = 0.003) and e′-velocity (P = 0.003) and higher E/e′ ratio (P = 0.001), left atrial volume index (LAVI) (P = 0.046), LV end-diastolic volume (LVEDV) (P = 0.001), LV end-systolic volume (LVESV) (P = 0.001), and LV mass index (P = 0.009) than ARAD patients without HF. All procedures were successful. In contrast to blood pressure and renal function, there was a significant interaction in E/e′ (Pinteraction < 0.001) between time and HF, and ARAD patients with HF showed a significant (P < 0.001) decrease in E/e′ albeit those without HF. By the same token, there was a significant interaction in NYHA class (Pinteraction < 0.001), MLHFQ score (Pinteraction = 0.018), E-velocity (Pinteraction = 0.002), LAVI (Pinteraction = 0.001), LVEDV (Pinteraction = 0.003), and LVESV (Pinteraction = 0.001) between time and HF with a significant improvement in all these variables in ARAD patients with HF (NYHA class, P = 0.001; MLHFQ score, P = 0.002; E-velocity, P = 0.005; LAVI, P = 0.001; LVEDV, P = 0.017; and LVESV, P = 0.011). Conclusions: Change in LV filling pressure after renal stenting differed between ARAD patients with and without HF, with a significant improvement in LV filling pressure in patients with HF-ARAD. These unique findings might support clinical cardiac benefits of renal artery stenting in ARAD patients with HF.

AB - Aims: Consensus-derived guidelines recommend renal stenting for patients with atherosclerotic renal artery disease (ARAD) and heart failure (HF). The aim of this prospective multi-centre observational study was to verify our hypothesis that changes in E/e′, an echocardiographic correlate of left ventricular (LV) filling pressure, following renal stenting may differ between ARAD patients with and without HF. Methods and results: This study enrolled de novo ARAD patients undergoing renal stenting at 14 institutions. The primary endpoint was the difference in E/e′ change between ARAD patients with and without HF. Clinical and echocardiographic data were prospectively collected at baseline, the day following renal stenting, and 1 month and 6 months afterwards. ARAD patients with HF were defined as patients with New York Heart Association (NYHA) Class 2 and more, or a history of HF hospitalization. A total of 76 patients were included, and 39% were ARAD patients with HF. ARAD patients with HF had significantly lower estimated glomerular filtration rate (P = 0.028) and higher NYHA functional class (P < 0.001) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (P = 0.001) than ARAD patients without HF. Also, ARAD patients with HF had significantly lower LV ejection fraction (P = 0.003) and e′-velocity (P = 0.003) and higher E/e′ ratio (P = 0.001), left atrial volume index (LAVI) (P = 0.046), LV end-diastolic volume (LVEDV) (P = 0.001), LV end-systolic volume (LVESV) (P = 0.001), and LV mass index (P = 0.009) than ARAD patients without HF. All procedures were successful. In contrast to blood pressure and renal function, there was a significant interaction in E/e′ (Pinteraction < 0.001) between time and HF, and ARAD patients with HF showed a significant (P < 0.001) decrease in E/e′ albeit those without HF. By the same token, there was a significant interaction in NYHA class (Pinteraction < 0.001), MLHFQ score (Pinteraction = 0.018), E-velocity (Pinteraction = 0.002), LAVI (Pinteraction = 0.001), LVEDV (Pinteraction = 0.003), and LVESV (Pinteraction = 0.001) between time and HF with a significant improvement in all these variables in ARAD patients with HF (NYHA class, P = 0.001; MLHFQ score, P = 0.002; E-velocity, P = 0.005; LAVI, P = 0.001; LVEDV, P = 0.017; and LVESV, P = 0.011). Conclusions: Change in LV filling pressure after renal stenting differed between ARAD patients with and without HF, with a significant improvement in LV filling pressure in patients with HF-ARAD. These unique findings might support clinical cardiac benefits of renal artery stenting in ARAD patients with HF.

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