Intrarenal Doppler ultrasonography reflects hemodynamics and predicts prognosis in patients with heart failure

We aimed to clarify clinical implications of intrarenal hemodynamics assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in heart failure (HF). We performed a prospective observational study, and examined IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n=341). Seven patients were excluded in VTI analysis due to unclear imaging. The patients were divided into groups based on (A) VTI: high VTI (VTI >= 14.0 cm, n=231) or low VTI (VTI<14.0 cm, n=103); and (B) IRVF patterns: monophasic (n=36) or non-monophasic (n=305). We compared post-discharge cardiac event rate between the groups, and right-heart catheterization was performed in 166 patients. Cardiac index was lower in low VTI than in high VTI (P=0.04), and right atrial pressure was higher in monophasic than in non-monophasic (P=0.03). In the Kaplan-Meier analysis, cardiac event rate was higher in low VTI and monophasic groups (P<0.01, respectively). In the Cox proportional hazard analysis, the combination of low VTI and a monophasic IRVF pattern was a predictor of cardiac events (P<0.01). IRD imaging might be associated with cardiac output and right atrial pressure, and prognosis.