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Quilty F, Abel AAI, Clark AL. Bilateral renal artery revascularisation in heart failure. BMJ Case Rep 2024; 17:e256323. [PMID: 38663899 PMCID: PMC11043742 DOI: 10.1136/bcr-2023-256323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Renal artery stenosis can complicate the management of heart failure with reduced ejection fraction, as it is a conventional contraindication to the use of ACE inhibitors. We report a case in which bilateral renal artery revascularisation allowed the safe reintroduction of enalapril (and subsequently sacubitril valsartan) in a patient with severe left ventricular systolic dysfunction. There is a role for renal artery angioplasty in selected patients to allow optimal medical therapy for patients with heart failure due to impaired systolic function.
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Affiliation(s)
- Finny Quilty
- Department of Cardiorespiratory Medicine, Hull York Medical School, Hull, UK
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Cuthbert JJ, Pellicori P, Rigby AS, Abel AAI, Kalvickbacka-Bennet A, Shah P, Kearsley JW, Kazmi S, Cleland JGF, Clark AL. Are non-invasive estimations of plasma volume an accurate measure of congestion in patients with chronic heart failure? Eur Heart J Qual Care Clin Outcomes 2023; 9:281-292. [PMID: 35723241 DOI: 10.1093/ehjqcco/qcac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 05/17/2023]
Abstract
AIMS We report associations between different formulae for estimating plasma volume status (PVS) and clinical and ultrasound markers of congestion in patients with chronic heart failure (CHF) enrolled in the Hull Lifelab registry. METHODS AND RESULTS Cohort 1 comprised patients with data on signs and symptoms at initial evaluation (n = 3505). Cohort 2 included patients with ultrasound assessment of congestion [lung B-line count, inferior vena cava (IVC) diameter, jugular vein distensibility (JVD) ratio] (N = 341). Two formulae for PVS were used: (a) Hakim (HPVS) and (b) Duarte (DPVS). Results were compared with clinical and ultrasound markers of congestion. Outcomes assessed were mortality and the composite of heart failure (HF) hospitalisation and all-cause mortality. In cohort 1, HPVS was associated with mortality [hazard ratio (HR) per unitary increase = 1.02 (1.01-1.03); P < 0.001]. In cohort 2, HPVS was associated with B-line count (HR) = 1.05 [95% confidence interval (CI) (1.01-1.08); P = 0.02] and DPVS with the composite outcome [HR = 1.26 (1.01-1.58); P = 0.04]. HPVS and DPVS were strongly related to haemoglobin concentration and HPVS to weight. After multivariable analysis, there were no strong or consistent associations between PVS and measures of congestion, severity of symptoms, or outcome. By contrast, log[NTproBNP] was strongly associated with all three. CONCLUSION Amongst patients with CHF, HPVS and DPVS are not strongly or consistently associated with clinical or ultrasound evidence of congestion, nor clinical outcomes after multivariable adjustment. They appear only to be surrogates of the variables from which they are calculated with no intrinsic clinical utility.
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Affiliation(s)
- J J Cuthbert
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - P Pellicori
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A S Rigby
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - A A I Abel
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - A Kalvickbacka-Bennet
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - P Shah
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J W Kearsley
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - S Kazmi
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J G F Cleland
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A L Clark
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
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