{"title":"间断多普勒衍生肾内静脉流量是急性冠脉综合征患者运动能力受损与不良预后相关的预测因子","authors":"Kenji Masada, Kento Fujita, Misato Saito, Masashi Kodama, Yoji Sumimoto, Takashi Shimonaga, Haruyuki Kinoshita, Hiroshi Sugino","doi":"10.1111/echo.70192","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Doppler-derived intrarenal venous flow (IRVF) has recently been used to assess renal congestion and intrarenal hemodynamics. Although several reports suggest that IRVF is useful for predicting the prognosis of patients with heart failure (HF), information is sparse for patients with acute coronary syndrome (ACS). Therefore, we performed a study to investigate the relationship between IRVF and peak oxygen consumption (VO<sub>2</sub>), which is associated with prognosis in patients with ACS.</p>\n </section>\n \n <section>\n \n <h3> Methods and Results</h3>\n \n <p>We enrolled 80 patients with ACS. The prevalence of discontinuous IRVF (DIRVF) was higher in patients with peak VO<sub>2</sub> less than the group median (13.2 mL/min/kg; 38% vs. 8%, <i>p</i> = 0.003). Multivariable logistic regression analyses indicated that DIRVF was the only independent predictor of peak VO<sub>2</sub> <12 mL/min/kg (odds ratio 6.33, 95% confidence interval [CI] 1.28−31.1, <i>p</i> = 0.02). Median follow-up was 366 days [189−513 days]. The occurrence of composite endpoints, including death from cardiovascular disease and unplanned hospitalization for HF, was significantly higher in patients with DIRVF than in those with continuous IRVF (<i>p =</i> 0.001). Moreover, according to receiver operating characteristic curves, the area under the curve obtained with basic clinical variables (age, sex, and log N-terminal pro-B-type-natriuretic peptide) was 0.72 (95% CI 0.60−0.83); this increased significantly to 0.84 (95% CI 0.75−0.93) when peak early diastolic mitral inflow velocity to early diastolic velocity ratio (E/e’) and DIRVF were added (<i>p</i> = 0.007).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>DIRVF predicts impaired exercise capacity, which is associated with poor prognosis, in patients with ACS.</p>\n </section>\n </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 6","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70192","citationCount":"0","resultStr":"{\"title\":\"Discontinuous Doppler-Derived Intrarenal Venous Flow Is a Predictor of Impaired Exercise Capacity Associated With Poor Prognosis in Patients With Acute Coronary Syndrome\",\"authors\":\"Kenji Masada, Kento Fujita, Misato Saito, Masashi Kodama, Yoji Sumimoto, Takashi Shimonaga, Haruyuki Kinoshita, Hiroshi Sugino\",\"doi\":\"10.1111/echo.70192\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Doppler-derived intrarenal venous flow (IRVF) has recently been used to assess renal congestion and intrarenal hemodynamics. Although several reports suggest that IRVF is useful for predicting the prognosis of patients with heart failure (HF), information is sparse for patients with acute coronary syndrome (ACS). Therefore, we performed a study to investigate the relationship between IRVF and peak oxygen consumption (VO<sub>2</sub>), which is associated with prognosis in patients with ACS.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods and Results</h3>\\n \\n <p>We enrolled 80 patients with ACS. The prevalence of discontinuous IRVF (DIRVF) was higher in patients with peak VO<sub>2</sub> less than the group median (13.2 mL/min/kg; 38% vs. 8%, <i>p</i> = 0.003). Multivariable logistic regression analyses indicated that DIRVF was the only independent predictor of peak VO<sub>2</sub> <12 mL/min/kg (odds ratio 6.33, 95% confidence interval [CI] 1.28−31.1, <i>p</i> = 0.02). Median follow-up was 366 days [189−513 days]. The occurrence of composite endpoints, including death from cardiovascular disease and unplanned hospitalization for HF, was significantly higher in patients with DIRVF than in those with continuous IRVF (<i>p =</i> 0.001). Moreover, according to receiver operating characteristic curves, the area under the curve obtained with basic clinical variables (age, sex, and log N-terminal pro-B-type-natriuretic peptide) was 0.72 (95% CI 0.60−0.83); this increased significantly to 0.84 (95% CI 0.75−0.93) when peak early diastolic mitral inflow velocity to early diastolic velocity ratio (E/e’) and DIRVF were added (<i>p</i> = 0.007).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>DIRVF predicts impaired exercise capacity, which is associated with poor prognosis, in patients with ACS.</p>\\n </section>\\n </div>\",\"PeriodicalId\":50558,\"journal\":{\"name\":\"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques\",\"volume\":\"42 6\",\"pages\":\"\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70192\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/echo.70192\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/echo.70192","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
多普勒衍生肾内静脉流量（IRVF）最近被用于评估肾充血和肾内血流动力学。尽管一些报道表明IRVF可用于预测心力衰竭（HF）患者的预后，但对于急性冠脉综合征（ACS）患者的预后信息却很少。因此，我们进行了一项研究，探讨IRVF与ACS患者预后相关的峰值耗氧量（VO2）之间的关系。方法与结果入选80例ACS患者。VO2峰值小于组中位值(13.2 mL/min/kg；38% vs. 8%, p = 0.003)。多变量logistic回归分析显示，DIRVF是VO2和lt峰值12 mL/min/kg的唯一独立预测因子（优势比6.33,95%可信区间[CI] 1.28 ~ 31.1, p = 0.02）。中位随访时间为366天[189 ~ 513天]。复合终点的发生率，包括心血管疾病死亡和心衰非计划住院，在DIRVF患者中显著高于持续IRVF患者（p = 0.001）。此外，根据受试者工作特征曲线，与基本临床变量（年龄、性别、log n端前b型利钠肽）相关的曲线下面积为0.72 (95% CI 0.60 ~ 0.83)；当增加舒张早期峰值二尖瓣流入速度与舒张早期速度比（E/ E’）和DIRVF时，这一数值显著增加至0.84 (95% CI 0.75 - 0.93) （p = 0.007）。结论：在ACS患者中，DIRVF可预测与预后不良相关的运动能力受损。
Discontinuous Doppler-Derived Intrarenal Venous Flow Is a Predictor of Impaired Exercise Capacity Associated With Poor Prognosis in Patients With Acute Coronary Syndrome
Background
Doppler-derived intrarenal venous flow (IRVF) has recently been used to assess renal congestion and intrarenal hemodynamics. Although several reports suggest that IRVF is useful for predicting the prognosis of patients with heart failure (HF), information is sparse for patients with acute coronary syndrome (ACS). Therefore, we performed a study to investigate the relationship between IRVF and peak oxygen consumption (VO2), which is associated with prognosis in patients with ACS.
Methods and Results
We enrolled 80 patients with ACS. The prevalence of discontinuous IRVF (DIRVF) was higher in patients with peak VO2 less than the group median (13.2 mL/min/kg; 38% vs. 8%, p = 0.003). Multivariable logistic regression analyses indicated that DIRVF was the only independent predictor of peak VO2 <12 mL/min/kg (odds ratio 6.33, 95% confidence interval [CI] 1.28−31.1, p = 0.02). Median follow-up was 366 days [189−513 days]. The occurrence of composite endpoints, including death from cardiovascular disease and unplanned hospitalization for HF, was significantly higher in patients with DIRVF than in those with continuous IRVF (p = 0.001). Moreover, according to receiver operating characteristic curves, the area under the curve obtained with basic clinical variables (age, sex, and log N-terminal pro-B-type-natriuretic peptide) was 0.72 (95% CI 0.60−0.83); this increased significantly to 0.84 (95% CI 0.75−0.93) when peak early diastolic mitral inflow velocity to early diastolic velocity ratio (E/e’) and DIRVF were added (p = 0.007).
Conclusions
DIRVF predicts impaired exercise capacity, which is associated with poor prognosis, in patients with ACS.
期刊介绍：
Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.
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