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01.06.2015 | Magnetic Resonance

The pathophysiology of the chronic cardiorenal syndrome: a magnetic resonance imaging study

verfasst von: Tobias Breidthardt, Eleanor F. Cox, Iain Squire, Aghogho Odudu, Nur Farhayu Omar, Mohamed Tarek Eldehni, Susan T. Francis, Christopher W. McIntyre

Erschienen in: European Radiology | Ausgabe 6/2015

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Abstract

Objective

To study the association of renal function with renal perfusion and renal parenchymal structure (T₁ relaxation) in patients with chronic heart failure (HF).

Methods

After IRB approval, 40 participants were enrolled according to HF and renal function status [10 healthy volunteers < 40 years; 10 healthy age-matched volunteers; 10 HF patients eGFR > 60 ml/min/1.73 m²; 10 HF patients eGFR < 60 ml/min/1.73 m²] and assessed by MRI. To be eligible for enrolment all HF patients with renal dysfunction (RD) needed to be diagnosed as having chronic cardiorenal syndrome based on current guidelines. Patients with primary kidney disease were excluded.

Results

Renal cortical perfusion correlated with eGFR values (r = 0.52;p < 0.01) and was similar between HF patients with and without RD (p = 0.27). T₁ relaxation correlated negatively with eGFR values (r = -0.41;p > 0.01) and was higher in HF patients compared to volunteers (1121 ± 102 ms vs. 1054 ± 65 ms;p = 0.03). T₁ relaxation was selectively prolonged in HF patients with RD (1169 ms ± 100 vs. HF without RD 1067 ms ± 79;p = 0.047). In linear regression analyses coronary artery disease (p = 0.01), hypertension (p = 0.04), and diabetes mellitus (p < 0.01) were associated with T₁ relaxation.

Conclusion

RD in HF is not primarily mediated by decreased renal perfusion. Instead, chronic reno-parenchymal damage, as indicated by prolonged T₁ relaxation, appears to underly chronic cardiorenal syndrome.

Key points

• The pathophysiology underlying chronic cardiorenal syndrome is not completely understood.

• Chronic cardiorenal syndrome is independent of cardiac output or renal perfusion.

• Renal T ₁ relaxation appears to be prolonged in HF with renal impairment.

• Renal T ₁ relaxation is associated with classic cardiovascular risk factors.

• Association of renal T ₁ relaxation with parenchymal damage should be validated further.

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Titel: The pathophysiology of the chronic cardiorenal syndrome: a magnetic resonance imaging study
verfasst von: Tobias Breidthardt
Eleanor F. Cox
Iain Squire
Aghogho Odudu
Nur Farhayu Omar
Mohamed Tarek Eldehni
Susan T. Francis
Christopher W. McIntyre
Publikationsdatum: 01.06.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 6/2015
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3571-5

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The pathophysiology of the chronic cardiorenal syndrome: a magnetic resonance imaging study