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

研究成果: Contribution to journalArticle査読

3 被引用数 (Scopus)

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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′ (P interaction  < 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 (P interaction  < 0.001), MLHFQ score (P interaction  = 0.018), E-velocity (P interaction  = 0.002), LAVI (P interaction  = 0.001), LVEDV (P interaction  = 0.003), and LVESV (P interaction  = 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 stenting in ARAD patients with HF.

本文言語英語
ページ(範囲)319-327
ページ数9
ジャーナルESC Heart Failure
6
2
DOI
出版ステータス出版済み - 4 2019
外部発表はい

All Science Journal Classification (ASJC) codes

  • 循環器および心血管医学

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