LAUSR

In arterial hypertension (HTN), vascular structural changes develop as a consequence of haemodynamic as well as neurohumoral factors. Indeed, in the peripheral vessels a decrease in arterial compliance and, in the heart remodelling occurs respectively. The significant impact of HTN on left heart remodelling and its interconnection with intrarenal hemodynamics (IRH) has been widely studied. In the same time, there is lack of data concerning the affinity of HTN, IRH and right heart remodelling, as another important cluster of factors for prediction of mortality and morbidity in this group of patients. The study included 104 patients (50 females and 54 males, mean age 48,26±11,2 years) with grade I-III arterial hypertension. All subjects underwent careful clinical history and physical examination to reveal risk factors, cardiovascular history and treatments. Blood test, echocardiography focused on right heart evaluation, intrarenal Doppler measurements were repeated in three parts of both kidneys (superior, median, and lower) untill three reproducible waveforms were obtained. The following IRH parameters were obtained: renal resistive index (RRI), renal pulsatile index (RPI), acceleration time (AT), renal volume (RV) and RV/RRI ratio. The mean RRI was 0,6672±0,0452, mean RPI 1,2533±0,178, mean AT 66,68±2,324 ms, mean RV 129,67±23,79 ml and mean RV/IRR ratio 195,52±41,587 ml. Mean 24 hours SBP was 146,12±13,96 mmHg, mean 24 hours DBP 86,59±6,78 mmHg. The mean pulse pressure (PP) was 59,10±22,90 mmHg. The mean 24 hours heart rate (HR) was 75,14±26,86 beats/minute. Mean value for the right ventricular (RV) basal diameter (4Ch) was 29,5±3,71 mm, right atrium (RA) diameter 39,71±3,38 mm, RA area 16,98±2,89 mm2, Sm RV 0,11±0,05 mm/sec, TAPSE 19,2±1,66 mm, SPAP 28,3±5,321 mmHg. We found an important positive correlation between RA diameter and RA area with RRI (r=0,364, p<0,01), (r=0,371, p<0,01), RPI (r=0,296, p<0,01), (r=0,320, p<0,01) and AT (r=0,155, p<0,05), (r=0,148, p<0,05), and negative correlation of RV Sm with RRI (r=−0,259, p<0,01), RPI (r=−0,232, p<0,01), AT (r=−0,162, p<0,05), meanwhile PASP showed an important positive connection with RRI (r=0,354, p<0,01), RPI (r=0,330, p<0,01) and AT (r=0,218, p<0,01). The assumption that cardiac structural changes are progressing in parallel with extracardiac target damage could have an important scientific substrate, emphasizing the potential connection of IRH and the heart remodelling, including the right heart in HTN, and the eventual strengthening the IRH positions as a predictor of cardiovascular outcomes in this subset of population.