Heart failure
Epidemiology, Associated Factors, and Prognostic Outcomes of Renal Artery Stenosis in Chronic Heart Failure Assessed by Magnetic Resonance Angiography

https://doi.org/10.1016/j.amjcard.2007.02.098Get rights and content

Our aim was to determine the prevalence, morbidity, and mortality associated with the presence of significant renal artery stenosis (RAS) in patients with chronic heart failure (HF), and to explore the use of angiotensin-converting enzyme (ACE) inhibitors and diuretics in this population during a 3-year follow-up period. We identified 97 patients with significant renal dysfunction (RD, defined as a calculated glomerular filtration rate of <60 ml/min) and 38 patients without RD, with ejection fractions of <40%. A stenosis of >50% using magnetic resonance angiography of the renal arteries was used to define significant RAS. Seventy-three (54%) patients had significant RAS of ≥1 artery. Mean follow-up time was 37.3 (± 7.9) months. Compared with patients with no significant RAS, these patients were on higher doses of diuretics, lower doses of ACE inhibitors, had prolonged hospital admissions, were admitted with exacerbation of HF, and had a higher mortality (p = 0.007 for mortality). In conclusion, RAS is common in patients with chronic HF, especially among patients with RD and is a predictor of a poor clinical outcome. Interventional trials on renal revascularization are underway that contain subsets of patients with HF that may provide evidence on how best to manage RAS in this setting.

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Methods

All participants provided written informed consent, and the study was carried out in accordance with the Declaration of Helsinki and the European Standards for Good Clinical Research Practice. Ethical approval was granted by the Local Research Ethics Committee.

This was a single center, observational, prospective study. Cross-sectional data were used to determine prevalence and longitudinal data were analyzed to assess changes and prognostic outcomes.

All patients were enrolled from a

Results

The average age of the population was 70 ± 1 years; 77% were men and had a mean left ventricular ejection fraction of 36 ± 1 %. Table 1 shows the prevalence of RAS in the whole population separated by the left or right renal artery. Eighty-nine patients (66%) had some degree of RAS, 73 (54%) had RAS of >50%, and 32 (24%) had bilateral RAS of >50%. The baseline demographic, clinical, and laboratory characteristics of the patients, divided by the presence or absence of RD are given Table 2.

Discussion

This is the first study to demonstrate that RAS is associated with an increase in morbidity and mortality in patients with chronic HF. We have also confirmed that RAS is common and associated with RD in this population.

There are only a few reports on the prevalence of RAS in patients with chronic HF. One involved 86 patients with heart failure aged >70 years (mean, 77.5, 49% women) who had a serum creatinine <300 μmol/l (34 mg/ml) and were ACE inhibitor naïve. The potential of renal MRA to

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