Duong Michael H, Mackenzie Todd A, Zwolak Robert M, Kaplan Aaron V, Robb John F, Thompson Craig A
Department of Medicine, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Lebanon, NH 03756, USA.
J Vasc Surg. 2007 Feb;45(2):284-8. doi: 10.1016/j.jvs.2006.09.041.
Determining renal resistive index (RI) in the setting of renal artery stenosis may predict which patients benefit from revascularization. Renal duplex ultrasonography (RDUS) is the traditional method of assessing RI, but it is not available in most invasive endovascular laboratories. Conversely, endovascular techniques to assess RI are available but not well validated. The primary goal was to determine if an invasive approach using an endovascular Doppler flow wire correlates with RI assessment using traditional noninvasive RDUS.
In a single-center prospective trial, patients were enrolled if they had known or suspected renovascular disease. A Doppler flow wire was placed in multiple segments of the renal artery, and peak (PSV) and end-diastolic velocities (EDV) were measured. RI was calculated using the formula: RI = [1 - (EDV/PSV)] x 100. Similarly, RI was also derived using standard RDUS. All patients underwent both RI techniques before any revascularization procedure. Secondary end points included assessing the correlation for pole-to-pole renal length assessment and PSV and EDV velocities using both invasive and noninvasive techniques. Pearson correlation coefficient calculations were used to determine degree of correlation.
The study enrolled 20 patients, and 35 renal arteries were studied. Overall, Pearson correlation coefficient for invasive vs noninvasive RI assessment was 0.86 (95% confidence interval [CI], 0.73 to 0.93). The r values were 0.43 (95% CI, 0.11 to 0.67) for pole-to-pole renal length, 0.66 (95% CI, 0.54 to 0.76) for PSV, and 0.61 (95% CI, 0.48 to 0.72) for EDV determination. No major complications occurred during this study. Average time to perform invasive Doppler assessment was 10.4 +/- 7.4 minutes per artery.
Invasive RI assessment using an endovascular flow wire technique correlates well with traditional noninvasive RDUS. A moderate statistical correlation also exists for pole-to-pole renal length, PSV, and EDV determinations. The procedure is safe and can be performed rapidly.
在肾动脉狭窄情况下测定肾阻力指数（RI），可能预测哪些患者能从血运重建中获益。肾双功超声检查（RDUS）是评估RI的传统方法，但在大多数侵入性血管内实验室无法进行。相反，评估RI的血管内技术虽有，但未得到充分验证。主要目标是确定使用血管内多普勒血流导丝的侵入性方法与使用传统非侵入性RDUS评估RI是否相关。
在一项单中心前瞻性试验中，纳入已知或疑似肾血管疾病的患者。将多普勒血流导丝置于肾动脉的多个节段，测量峰值流速（PSV）和舒张末期流速（EDV）。使用公式RI = [1 - (EDV/PSV)] x 100计算RI。同样，也使用标准RDUS得出RI。所有患者在任何血运重建手术前均接受两种RI技术检查。次要终点包括使用侵入性和非侵入性技术评估极间肾长度评估以及PSV和EDV流速的相关性。使用Pearson相关系数计算来确定相关程度。
该研究纳入20例患者，研究了35条肾动脉。总体而言，侵入性与非侵入性RI评估的Pearson相关系数为0.86（95%置信区间[CI]，0.73至0.93）。极间肾长度的r值为0.43（95%CI，0.11至0.67），PSV的r值为0.66（95%CI，0.54至0.76），EDV测定的r值为0.61（95%CI，0.48至0.72）。本研究期间未发生重大并发症。每条动脉进行侵入性多普勒评估的平均时间为10.4 +/- 7.4分钟。
使用血管内血流导丝技术进行的侵入性RI评估与传统非侵入性RDUS相关性良好。极间肾长度、PSV和EDV测定也存在中度统计学相关性。该操作安全且可快速完成。
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