Aims An increase in right atrial pressure is a common feature of acute decompensated heart failure (ADHF). Such increased pressure leads to persistent kidney congestion. A marker to guide optimal diuretic therapy is missing. We aim to correlate intrarenal Doppler ultrasound (IRD) in ADHF patients with clinical outcomes to assess whether renal hemodynamic parameter changes are useful for monitoring kidney congestion. Methods Between December 2018 and January 2020, ADHF patients requiring intravenous diuretic therapy for at least 48 hours were considered for study selection. IRD blinded examination was performed day on 1, 3, 5 and clinical and laboratory parameters were recorded. Venous Doppler profile (VDP) were classified as continuous (C), pulsatile (P), biphasic (B), or monophasic (M) according to congestion degree; B and M profiles were considered deranged. VDP improvement (VDPimp) was defined as a change of ≥ 1 pattern degree or maintenance of C or P patterns. Arterial resistive index (RI) > 0.8 was considered elevated. Outcomes of death and rehospitalization were gathered at 60 days. Data were assessed by regression and Kaplain Meier analyses. Results All 177 ADHF patients admitted were screened and 72 were enrolled (27 females - median age 81 [76-87] years - median EF 40% [30-52]). VDP derangement decreased from 79.2% on day 1 to 51.4% on day 5 (p < 0.05). RI elevation decreased from 60.6% on day 1 to 43.1% on day 5 (p < 0.05). At day 5, VDPimp was registered in over half of the patients (59.7%). At day 5, signs of congestion (dyspnea/edema/rales), fluid accumulation (pleural/peritoneal fluid), hematocrit, and BNP improved (p > 0.05). After 60 days, 12 (16.7%) patients were readmitted and 9 (12.5%) died. VDPimp was identified as the unique independent factor associated with readmission (OR 0.22 CI 95% 0.05-0.94, p = 0.04) and death (OR 0.07, CI 95% 0.01-0.68, p = 0.02), with significantly better outcomes identified in VDPimp patients (Log Rank test p < 0.05). Conclusions Decongestion may be associated with improvements in many clinical and instrumental parameters, but only VDPimp was associated with better clinical outcome. VDPimp should be incorporated in ad hoc AHF clinical trials to better define its role in everyday practice.

中文翻译：

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肾内静脉多普勒作为急性心力衰竭患者最佳减充血、治疗和预后的新标志物

目的 右心房压力升高是急性失代偿性心力衰竭 (ADHF) 的常见特征。这种增加的压力导致持续的肾脏充血。缺少指导最佳利尿治疗的标志物。我们的目标是将 ADHF 患者的肾内多普勒超声 (IRD) 与临床结果相关联，以评估肾脏血流动力学参数的变化是否有助于监测肾脏充血。方法 2018年12月至2020年1月期间，需要静脉利尿治疗至少48小时的ADHF患者被考虑纳入研究选择。在第 1、3、5 天进行 IRD 盲法检查，并记录临床和实验室参数。静脉多普勒图（VDP）根据充血程度分为连续性（C）、搏动性（P）、双相性（B）或单相性（M）；B型和M型被认为是精神错乱的。VDP 改善 (VDPimp) 定义为 ≥ 1 模式程度的改变或 C 或 P 模式的维持。动脉电阻指数(RI)＞0.8被认为是升高的。死亡和再住院结果在 60 天时收集。通过回归和 Kaplain Meier 分析评估数据。结果 所有 177 名 ADHF 患者均经过筛查，其中 72 名患者入组（27 名女性 - 中位年龄 81 [76-87] 岁 - 中位 EF 40% [30-52]）。VDP 紊乱从第 1 天的 79.2% 下降到第 5 天的 51.4% (p < 0.05)。RI 升高从第 1 天的 60.6% 下降到第 5 天的 43.1% (p < 0.05)。第 5 天，超过一半的患者 (59.7%) 登记了 VDPimp。第5天，充血症状（呼吸困难/水肿/啰音）、液体积聚（胸膜/腹膜液）、血细胞比容和BNP改善（p＞0.05）。60 天后，12 名患者（16.7%）再次入院，9 名患者（12.5%）死亡。VDPimp 被确定为与再入院（OR 0.22 CI 95% 0.05-0.94，p = 0.04）和死亡（OR 0.07，CI 95% 0.01-0.68，p = 0.02）相关的独特独立因素，VDPimp 中确定的结果明显更好患者（对数等级检验 p < 0.05）。结论 减充血可能与许多临床和仪器参数的改善相关，但只有 VDPimp 与更好的临床结果相关。VDPimp 应纳入临时 AHF 临床试验，以更好地确定其在日常实践中的作用。