Association of Time-to-Peak of Renal Blood Flow with Outcomes in Heart Failure: An Exploratory Comparative Analysis with Conventional Predictors
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Time-to-peak of renal blood flow (TTPr), derived from Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy, is a novel parameter for assessing renal perfusion.Aims: To evaluate the prognostic significance of TTPr in patients with heart failure (HF). Study Design: Retrospective, observational cohort study.Methods: We analyzed 304 patients with HF who underwent Tc-99m DTPA renal scintigraphy to assess TTPr.TTPr values were compared between deceased and surviving patients.Cox regression analyses evaluated the prognostic value of TTPr.Model performance was assessed using the C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).Bootstrap internal validation (200 repetitions) generated optimism-corrected estimates, and the Holm-Bonferroni correction accounted for multiple testing in secondary analyses.Results: During a median follow-up of 790 days, 79 patients (26.0%) died.For short-term outcomes (3-month mortality, n = 7), deceased patients showed a trend toward prolonged TTPr compared with survivors (59 s vs. 27 s, p = 0.008); multivariable analysis was not performed due to limited events.For long-term prognosis, TTPr was an independent predictor, demonstrating the highest corrected C-index among individual predictors (p < 0.001).After bootstrap correction, models incorporating TTPr [BM + TTPr and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) + TTPr] showed modest but significant C-index improvements for all-cause and cardiovascular mortality (BM + TTPr: corrected ΔC-index = +0.018and +0.020, both p < 0.01; MAGGIC + TTPr: corrected ΔC-index = +0.040and +0.062, both p < 0.001), with reduced AIC.After Holm-Bonferroni correction, MAGGIC + TTPr significantly improved IDI at 1, 3, and 5 years for both endpoints (all adjusted p = 0.012), whereas NRI improvements were not statistically significant.Survival analysis using exploratory cutoffs (35 s for all-cause mortality, 33 s for cardiovascular mortality) revealed lower cumulative survival in the prolonged TTPr group (p < 0.05); these cut-offs require external validation.Conclusion: Time-to-peak of renal blood predicted long-term outcomes in this HF cohort, showing potential incremental value.Prospective validation in broader populations is warranted before clinical implementation.
Source: Balkan Medical Journal
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7140506575
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