Background:Determinants of poor outcome in atherosclerotic cardiovascular disease (ASCVD) according to left ventricular ejection fraction (LVEF) are unclear. The renal resistive index (RRI) correlates well with atherosclerotic vascular damage, which, in turn, is correlated with cardiovascular outcomes. This study investigated whether high RRI is associated with poor cardiovascular outcomes in ASCVD patients classified by LVEF.

Methods and Results:Records of 1,598 acute coronary syndromes (ACS) and acute decompensated heart failure (ADHF) patients, categorized into preserved (p), mid-range (mr), and reduced (r) ejection fraction (EF) groups (EF ≥50% [n=1,130], 40–50% [n=223], and <40% [n=245], respectively), were analyzed retrospectively. The primary endpoint was any cardiovascular-related event: fatal and non-fatal ACS, ADHF, stroke, and sudden cardiac death. Over 1.9-years follow-up (3,030 person-years), 233 events occurred: 122, 37, and 74 in the pEF, mrEF, and rEF groups, respectively. Adjusted Cox regression analysis revealed RRI ≥0.8 was associated with the primary endpoint in the pEF group (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.09–2.56), but not in the mrEF or rEF groups. The primary endpoint risk of pEF patients with an RRI ≥0.8 was comparable to that of mrEF patients using the pEF+RRI <0.8 group as the reference (HR 1.89 [95% CI 1.26–2.83] and 1.77 [95% CI 1.19–2.63], respectively).

Conclusions:RRI was associated with the risk of cardiovascular events in ASCVD patients with pEF.

背景：根据左心室射血分数 (LVEF)，动脉粥样硬化性心血管疾病 (ASCVD) 预后不良的决定因素尚不清楚。肾阻力指数 (RRI) 与动脉粥样硬化血管损伤密切相关，而动脉粥样硬化血管损伤又与心血管结局相关。本研究调查了高 RRI 是否与按 LVEF 分类的 ASCVD 患者的不良心血管结局相关。

方法和结果：1,598 名急性冠状动脉综合征 (ACS) 和急性失代偿性心力衰竭 (ADHF) 患者的记录，分为保留 (p)、中程 (mr) 和降低 (r) 射血分数 (EF) 组（EF ≥ 50% [分别对 n=1,130、40–50% [n=223] 和 <40% [n=245]）进行了回顾性分析。主要终点是任何心血管相关事件：致死性和非致死性 ACS、ADHF、中风和心源性猝死。在 1.9 年的随访中（3,030 人年），发生了 233 起事件：pEF、mrEF 和 rEF 组分别发生了 122、37 和 74 起事件。调整后的 Cox 回归分析显示 RRI ≥ 0.8 与 pEF 组的主要终点相关（风险比 [HR] 1.67；95% 置信区间 [CI] 1.09-2.56），但与 mREF 或 rEF 组无关。RRI ≥ 0 的 pEF 患者的主要终点风险。

结论： RRI 与具有 pEF 的 ASCVD 患者的心血管事件风险相关。