European Heart Journal Advance Access originally published online on May 26, 2005
European Heart Journal 2005 26(16):1596-1605; doi:10.1093/eurheartj/ehi304
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Atherosclerotic renovascular disease in chronic heart failure: should we intervene?
1Academic Cardiology, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
2Department of Nephrology, Hull Royal Infirmary, Hull, East Yorkshire, HU3 2JZ, UK
3Department of Vascular Radiology, Leeds General Infirmary, Leeds, West Yorkshire, LS1 3EX, UK
Received 9 July 2004; revised 10 January 2005; accepted 31 March 2005; online publish-ahead-of-print 26 May 2005.
* Corresponding author. Tel: +44 1482 624073; fax: +44 1482 624085. E-mail address: ramesh{at}desilva84.freeserve.co.uk
See page 1576 for the editorial comment on this article (doi:10.1093/eurheartj/ehi375)
Renal artery stenosis (RAS) is most commonly caused by atherosclerosis, which is also the most common cause of chronic heart failure (CHF). One-third of patients with CHF are reported to have significant renovascular disease. The presence of RAS confers a worse outcome in studies of hypertension and coronary disease, though data are lacking for patients with CHF. As the kidney is intricately involved in the fluid retention that occurs in CHF, an adverse effect of RAS on outcome would be expected. Presentations of RAS in CHF include flash pulmonary oedema, hypertension, worsening of CHF, and worsening renal function. RAS commonly progresses and may cause worsening of renal function in patients with CHF and previously stable renal function. A variety of investigations that can safely and accurately identify RAS in CHF are available, although none is recommended in current guidelines for the management of CHF. Treatment for RAS, whether for hypertension, for renal dysfunction, or for pulmonary oedema, is at the discretion of the physician due to the lack of adequate randomized controlled trials demonstrating the efficacy and safety of intervention. As it is not clear how RAS should be managed in CHF, screening cannot be advocated. Currently, a multicentre randomized outcome trial, which includes a cohort of patients with RAS and CHF, is in progress to provide answers in this area of uncertainty.
Key Words: Heart failure • Renovascular disease • Intervention
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in EHJ:
- Cardiology and nephrology: time for a more integrated approach to patient care?
- Alex Hobson, Philip A. Kalra, and Paul R. Kalra
EHJ 2005 26: 1576-1578.[Extract] [Full Text]
This article has been cited by other articles:
|
|
 |
|
  H. Guo, P. A. Kalra, D. T. Gilbertson, J. Liu, S.-C. Chen, A. J. Collins, and R. N. Foley Atherosclerotic Renovascular Disease in Older US Patients Starting Dialysis, 1996 to 2001 Circulation, January 2, 2007; 115(1): 50 - 58. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. de Silva, N. P. Nikitin, K. K.A. Witte, A. S. Rigby, K. Goode, S. Bhandari, A. L. Clark, and J. G.F. Cleland Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis Eur. Heart J., March 1, 2006; 27(5): 569 - 581. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Hobson, P. A. Kalra, and P. R. Kalra Cardiology and nephrology: time for a more integrated approach to patient care? Eur. Heart J., August 2, 2005; 26(16): 1576 - 1578. [Full Text] [PDF]
|
|