Renal resistive index in patients supported with a durable continuous flow left ventricular assist device

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL Artificial organs Pub Date : 2024-09-05 DOI:10.1111/aor.14854

S. Barua, D. Robson, H. Eckford, P. Macdonald, K. Muthiah, C. S. Hayward

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Abstract

Background

The impact of continuous flow resulting from contemporary left ventricular assist devices (LVAD) on renal vascular physiology is unknown. Renal resistive index (RRI) reflects arterial compliance, as well as renal vascular resistance, contributed by afferent and efferent arteriolar tone, the renal interstitium as well as renal venous pressures.

Methods

Prospective, single center study with renal Doppler evaluation at baseline (pre-implant) and at 3-months support. Outcomes assessed include need for post-operative renal replacement therapy (RRT), worsening renal function (WRF) defined as persistent increase from pre-implant KDIGO chronic kidney disease stage, right ventricular (RV) failure, and survival to transplantation.

Results

Pre-implant RRI did not predict cardiorenal outcomes including right heart failure, need for renal replacement therapy or worsening renal function. Post-implant RRI was significantly lower than pre-implant RRI, with a distinct Doppler waveform characteristic of continuous flow. Post-implant renal end-diastolic velocity, but not RRI, correlated strongly with LVAD flow (Spearman rho −0.99, p < 0.001), with trend toward correlation with mean arterial pressure (Spearman's rho 0.63, p = 0.129). There was a negative correlation between post-implant RRI and mean pulmonary artery pressure (Spearman's rho −0.81, p = 0.049), likely driven by elevated pulmonary capillary wedge pressure (Spearman's rho −0.83, p = 0.058).

Conclusion

The hemodynamic contributors to RRI in LVAD supported patients are complex. Higher mean pulmonary artery and pulmonary capillary wedge pressures seen in lower RRI may reflect a smaller difference in systolic and diastolic flow. Future simultaneous Doppler assessment of the LVAD outflow graft and RRI may help understand the hemodynamic interactions contributing to this index.

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使用耐用持续流左心室辅助装置的患者的肾阻力指数。

背景：当代左心室辅助装置（LVAD）产生的持续血流对肾脏血管生理学的影响尚不清楚。肾脏阻力指数（Renal Resistive Index，RRI）反映了动脉顺应性以及肾脏血管阻力，由传入和传出动脉张力、肾间质以及肾脏静脉压共同决定：前瞻性单中心研究，在基线（植入前）和 3 个月支持时进行肾脏多普勒评估。评估结果包括术后肾脏替代疗法（RRT）需求、肾功能恶化（WRF）（定义为移植前KDIGO慢性肾脏病分期持续上升）、右心室（RV）衰竭以及移植后存活率：结果：移植前的RRI并不能预测包括右心衰竭、肾替代治疗需求或肾功能恶化在内的心肾结果。移植后的RRI明显低于移植前的RRI，多普勒波形具有明显的连续流特征。植入后肾脏舒张末期速度与 LVAD 流量密切相关，但 RRI 与 LVAD 流量无关（Spearman rho -0.99，p）：LVAD 支持患者 RRI 的血液动力学因素非常复杂。RRI 较低时平均肺动脉压和肺毛细血管楔压较高，这可能反映出收缩期和舒张期血流差异较小。未来对 LVAD 流出移植物和 RRI 进行同步多普勒评估可能有助于了解导致该指数的血流动力学相互作用。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.