Abstract 011: Regression of Left Ventricle Hypertrophy and Improvement of Ventricular Dysfunction After Renal Revascularization is Dependent of Blood Pressure Response and Etiology of Renal Artery Stenosis

Whether patients with renal artery stenosis should undergo therapeutic revascularization is controversial. In this retrospective study, we evaluated prognostic intrarenal Doppler ultrasound parameters that might have a predictive value for a beneficial response after renal revascularization. From January 2003 until December 2012, all renovascular interventions for renal artery stenosis were analyzed. The resistive index and the maximal systolic acceleration were determined by Doppler ultrasonography prior to intervention. Thirty-two patients who underwent a renal revascularization procedure were included: 13 combined positive responders and 19 combined non-responders. The combined positive responders had a significant lower resistive index than the combined non-responders (0.5 vs. 0.6, P = 0.001) and a significant lower maximal systolic acceleration (1.0 vs. 3.8, P = 0.001) before revascularization. A prediction model (RI ≤ 0.5 and ACCmax ≤ 1.3 m/s2) was formulated to identify a subgroup that benefits from renal revascularization. This model has an expected sensitivity of 69% and specificity of 89% for improvement in renal function and/or blood pressure after revascularization. The non-invasive intrarenal Doppler ultrasound parameters resistive index and maximal systolic acceleration can be used as tools to predict improvement in renal function and/or blood pressure after revascularization of renal artery stenosis. The clinical value of this prediction model should be evaluated in a prospective trial.

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Elevated Brain Natriuretic Peptide Predicts Blood Pressure Response After Stent Revascularization in Patients With Renal Artery Stenosis

Circulation ◽

10.1161/01.cir.0000153271.77341.9f ◽

2005 ◽

Vol 111 (3) ◽

pp. 328-333 ◽

Cited By ~ 81

Author(s):

Jose A. Silva ◽

Albert W. Chan ◽

Christopher J. White ◽

Tyrone J. Collins ◽

J. Stephen Jenkins ◽

...

Keyword(s):

Blood Pressure ◽

Brain Natriuretic Peptide ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Natriuretic Peptide ◽

Blood Pressure Response ◽

Pressure Response ◽

Artery Stenosis

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Percutaneous Transluminal Angioplasty for Atheromatous Renal Artery Stenosis - Blood Pressure Response and Discriminant Analysis of Outcome Predictors

QJM ◽

10.1093/oxfordjournals.qjmed.a068457 ◽

1990 ◽

Keyword(s):

Blood Pressure ◽

Discriminant Analysis ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Percutaneous Transluminal Angioplasty ◽

Blood Pressure Response ◽

Transluminal Angioplasty ◽

Artery Stenosis ◽

Outcome Predictors ◽

Percutaneous Transluminal

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"Flash" pulmonary oedema as a clinical manifestation of renovascular hypertension

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0306208d ◽

2003 ◽

Vol 131 (5-6) ◽

pp. 208-210 ◽

Cited By ~ 1

Author(s):

Dimitra Kalimanovska-Ostric ◽

Branislava Ivanovic ◽

Vladimir Ostric ◽

Vesna Knezevic ◽

Vesna Stojanov ◽

...

Keyword(s):

Blood Pressure ◽

Abdominal Aortic Aneurysm ◽

Renal Artery ◽

Pulmonary Oedema ◽

Renal Artery Stenosis ◽

Left Ventricular ◽

Artery Stenosis ◽

Atherosclerotic Renal Artery Stenosis ◽

Renal Revascularization ◽

Abdominal Aortic

One of the clinical manifestations of renovascular hypertenzion (RVH) may be a recurrent pulmonary oedema both in the absence or in the presence of systolic left ventricular dysfunction. This type of pulmonary oedema characterized as "flash" pulmonary oedema is ascribed to elevated angiotensin II concentrations with consequent hypertension as well as to volume overload resulting from decreased pressure natriuresis when there are significant stenoses of both or one renal arteries. The investigation included 30 patients with RVH treated by percutaneous transluminal angioplasty of the stenosed renal artery (PTRA) and/or stent implantation (PTR-ST) and 30 patients with surgical resection of the abdominal aortic aneurysm (AAA). The first group was divided in two subgroups according to the etiology of renal artery stenosis (RAS). In the subgroup with fibromuscular dysplasia (FMD) the mean age was 37.5 years, in the subgroup with atherosclerotic renal artery stenosis (ARAS) 54.8 years and in the group with operated AAA 68.6 years. There were more females than males only in the FMD subgroup (10:3). Two patients of the first group experienced pulmonary oedema, both in the subgroup with atherosclerotic renal artery stenosis associated with atherosclerosis of other arteries. Normalization of the blood pressure following PTRA in both and an uncomplicated course after a surgical myocardial revascularization in one of them illustrates the importance of renal revascularization. Pulmonary oedema occurred preoperatively in four out of 30 patients with abdominal aortic aneurysm in whom significant renal artery stenoses coexisted. Two patients died despite surgery, one patient is clinically stable and the medicament treatment of heart failure is inevitable in the fourth with a left ventricular aneurysm following myocardial infarction. The occurrence or reoccurrence of pulmonary oedema in the absence of other explanation should suggest the possibilty of billateral or unilateral renal artery stenosis requiring renal revascularization for blood pressure regulation as well as for elimination of other manifestations/complications.

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