Intrarenal hemodynamics in arterial hypertension and heart failure with preserved ejection fraction

Abstract

Introduction: Traditional cardiovascular risk factors in the general population are usually correlated with the prognosis in patients with heart failure with preserved ejection fraction (HFpEF).Purpose: The aim of the present study was to assess the implications of intrarenal hemodynamics (IRH) in HFpEF.Material and methods: The research included 60 patients with HFpEF aged 18-79 years, All subjects underwent physical examination, 24-hours ambulatory BP and electrocardiography monitoring, echocardiography, intrarenal Doppler ultrasound, obtaining the following IRH parameters: renal resistive index (RRI), renal pulsatile index (RPI), acceleration time (AT). Results: The analysis of BP values showed that 22% (13 pts) had stage I HTN, 48% (29 pts) - stage II HTN and 30% ( 18 pts) – stage III HTN , whereas the mean age of HTN onset was 40,55 ± 10,27 years, the mean HTN duration being of 9,57 ± 7,12 years, mean ejection fraction 56 ± 4,562%, mean NT-proBNP levels 654 ± 93 pg/ml. There was a positive association of only IRR with ambulatory 24 hours SBP (r = 0,359, p < 0,01), mean daytime SBP (r = 0,260, p<0,05) ambulatory PP (r = 0,266, p < 0,01), age (r = 0,253, p< 0,01), left ventricular mass (r = 0,459, p < 0,001) and relative wall thickness (r = 0,293 p<0,01). Conclusions: In addition to local renal vascular properties, the central hemodynamic factors significantly influence the IRH in HFpEF. IRH is the result of a complex interaction between renal and systemic vascular factors useful in assessment of a large spectrum of cardiovascular conditions.