Risk of morbidity from renovascular disease in elderly patients with congestive cardiac failure

Renovasular disease commonly affects elderly people. Elderly patients with heart failure are routinely treated with angiotensin-converting-enzyme (ACE) inhibitors, which may increase risk of renal dysfunction. We investigated the frequency of renovascular disease among elderly people with heart fail...

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Bibliographic Details
Published in:The Lancet (British edition) 1998-07, Vol.352 (9121), p.13-16
Main Authors: MacDowall, P, Kalra, PA, O'Donoghue, DJ, Waldek, S, Mamtora, H, Brown, K
Format: Article
Language:English
Subjects:
Aged
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Captopril
Female
Heart Failure - complications
Heart Failure - drug therapy
Humans
Magnetic Resonance Angiography
Male
Radioisotope Renography
Renal Artery Obstruction - chemically induced
Renal Artery Obstruction - diagnosis
Renal Artery Obstruction - etiology
Sensitivity and Specificity
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Summary:Renovasular disease commonly affects elderly people. Elderly patients with heart failure are routinely treated with angiotensin-converting-enzyme (ACE) inhibitors, which may increase risk of renal dysfunction. We investigated the frequency of renovascular disease among elderly people with heart failure. From the local population of Salford, UK, we recruited 86 patients with heart failure with a mean age of 77.5 (SD 5.6) years, who were admitted as acute emergencies or who attended general medical clinics. We selected patients by intention to treat with ACE inhibitors. We used captopril renography to screen for renovascular disease. All patients with abnormal renograms underwent magnetic-resonance angiography of the renal arteries as well as 40% of patients with normal renograms as negative controls. Magnetic-resonance angiography showed severe renovascular disease (>50% renal-artery stenosis or occlusion) in 29 (34%) patients. Captopril renography had an estimated sensitivity of 78·8% (95% CI 72.7–97.8) and specificity of 94·3% (67.6–97.3) for detection of renovascular disease. The estimated positive predictive value of captopril renography was 89·7% and the negative predictive value was 87·5%. Patients with renovascular disease had worse renal function (mean creatinine 201 [SD 56] vs 136 [40] μmol/L, p
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(97)11060-1