Clinical relevance and prognostic value of renal Doppler in acute decompensated precapillary pulmonary hypertension.

Aims: We aim to evaluate the clinical relevance and the prognostic value of arterial and venous renal Doppler in acute decompensated precapillary pulmonary hypertension (PH).
Methods and Results: The renal resistance index (RRI) and the Doppler-derived renal venous stasis index (RVSI) were monitored at admission and on Day 3 in a prospective cohort of precapillary PH patients managed in intensive care unit for acute right heart failure (RHF). The primary composite endpoint included death, circulatory assistance, urgent transplantation, or rehospitalization for acute RHF within 90 days following inclusion. Ninety-one patients were enrolled (58% female, age 58 ± 16 years). The primary endpoint event occurred in 32 patients (33%). In univariate logistic regression analysis, variables associated with RRI higher than the median value were non-variable parameters (age and history of hypertension), congestion (right atrial pressure and renal pulse pressure), cardiac function [tricuspid annular plane systolic excursion (TAPSE) and left ventricular outflow tract- velocity time integral], systemic pressures and NT-proBNP. Variables associated with RVSI higher than the median value were congestion (high central venous pressure, right atrial pressure, and renal pulse pressure), right cardiac function (TAPSE), severe tricuspid regurgitation, and systemic pressures. Inotropic support was more frequently required in patients with high RRI (P = 0.01) or high RVSI (P = 0.003) at the time of admission. At Day 3, a RRI value <0.9 was associated with a better prognosis after adjusting to the estimated glomerular filtration rate.
Conclusion: Renal Doppler provides additional information to assess the severity of patients admitted to the intensive care unit for acute decompensated precapillary PH.
Competing Interests: Conflict of interest: Over the last 3 years, J. Pichon declares no conflicts of interest. A. Roche declares no conflicts of interest. C. Fauvel reports grants or contracts from Pfizer and Novartis, consulting fees from Janssen and Payment or honoraria for lectures from Pfizer outside the submitted work. A. Boucly reports grants or contracts from Acceleron, Janssen, and MSD and Payment or honoraria for lectures from Janssen, Merck, and AOP Orphan outside the submitted work. O. Mercier reports grants or contracts from Edwards Lifescience, and consulting fees from MSD outside the submitted work. N. Ebstein declares no conflicts of interest. A. Beurnier declares no conflicts of interest. J. Cortese declares no conflicts of interest. M. Jevnikar declares no conflicts of interest. X. Jais declares grants or contracts from Acceleron, Janssen, Bayer, Merck, and payment or honoraria for lectures from Janssen and Merck outside the submitted work. M. Fartoukh reports grants or contracts from Funding: Fondation du Souffle (Profil COV), Funding: Fondation de l’AP-HP (Multicov trial), BioMérieux, and Payment or honoraria for lectures from Fisher & Paykel, BioMérieux, and Other financial or non-financial interests forme Pfizer outside the submitted work. E. Fadel declares no conflicts of interest. O. Sitbon reports honoraria for speaking, steering committees, and scientific advisory boards from Janssen, Bayer, Merck, Gossamer Bio, Ferrer, and United Therapeutics. D. Montani reports grants and personal fees from Acceleron, Janssen, Merck, and consulting fees from Accelron, Merck, Janssen, and payment or honoraria for lectures from Bayer, Janssen, and Merck outside the submitted work. G. Voiriot declares no conflicts of interest. M. Humbert reports grants and personal fees from Acceleron, Aerovate, Altavant, AOP Orphan, Bayer, Chiesi, Ferrer, Janssen, Merck, MorphogenIX, and United Therapeutics and payment or honoraria from Janssen and Merck outside the submitted work. L. Savale reports personal fees from Janssen and Janssen and MSD outside the submitted work.
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