Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Nephrol Dial Transplant. 2010 Aug;25(8):2685-90. doi: 10.1093/ndt/gfq113. Epub 2010 Feb 26.
Decreased coronary flow reserve (CFR) is a marker of endothelial dysfunction, coronary artery calcification and inflammation, well-known cardiovascular risk factors in haemodialysis (HD) patients. In this study, we aimed to investigate the correlation of coronary artery calcification scores (CACS) with CFR in HD patients.
Sixty-four end-stage renal failure patients were enrolled in this study (38 males, 26 females). Thirty-nine healthy subjects (22 males, 17 females) were included in the control group. Biochemical parameters and acute-phase inflammation marker [high-sensitivity C-reactive protein (hs-CRP)] of patients were recorded before dialysis. The CACS were measured by electron beam computerized tomography method. CFR recordings were performed by trans-thoracic Doppler echocardiography. The relationship between CACS and CFR was evaluated.
The mean CACS was 281 +/- 589 and 29 patients had CACS < 10. Patients with CACS > 10 had significantly lower CFR values compared to patients with CACS < 10 (1.56 +/- 0.38 vs 1.84 +/- 0.53, P = 0.024). However, there was no difference in hs-CRP values between the groups. CFR was negatively correlated with CACS (r = -0.276, P = 0.030). In multiple stepwise regression analysis, CACS was found to be an independent variable for predicting CFR (P = 0.048). During a follow-up of 18 months, 10 patients had experience of cardiovascular events. Patients with CACS > 10 had significantly higher event rate [34.5% (10/29) vs 0% (0/24)] compared to those with CACS < 10 (P = 0.001). Patients who developed cardiovascular events had significantly higher mean CACS and lower CFR values than the remaining group (P = 0.019 and P = 0.039). All of four patients who died during follow-up were in the CFR < 2 and CACS > 10 groups.
CACS was associated with CFR in HD patients. However, we did not find any association of inflammation with CACS and CFR. This association between CFR and CACS might indicate two different (anatomical and functional) aspects of the common pathophysiology of the arterial system in HD patients.
降低的冠状动脉血流储备（CFR）是内皮功能障碍、冠状动脉钙化和炎症的标志物，这些都是血液透析（HD）患者众所周知的心血管危险因素。在这项研究中，我们旨在研究 HD 患者的冠状动脉钙化评分（CACS）与 CFR 的相关性。
本研究纳入了 64 例终末期肾衰竭患者（38 名男性，26 名女性）。39 名健康受试者（22 名男性，17 名女性）被纳入对照组。在透析前记录患者的生化参数和急性期炎症标志物[高敏 C 反应蛋白（hs-CRP）]。通过电子束计算机断层扫描方法测量 CACS。通过经胸多普勒超声心动图记录 CFR 记录。评估 CACS 与 CFR 之间的关系。
平均 CACS 为 281±589，29 例患者的 CACS<10。CACS>10 的患者 CFR 值明显低于 CACS<10 的患者（1.56±0.38 比 1.84±0.53，P=0.024）。然而，两组间 hs-CRP 值无差异。CFR 与 CACS 呈负相关（r=-0.276，P=0.030）。多元逐步回归分析显示，CACS 是预测 CFR 的独立变量（P=0.048）。在 18 个月的随访期间，10 例患者发生心血管事件。CACS>10 的患者事件发生率明显高于 CACS<10 的患者[34.5%（10/29）比 0%（0/24）]（P=0.001）。发生心血管事件的患者的平均 CACS 值和 CFR 值明显高于其余组（P=0.019 和 P=0.039）。在随访期间死亡的 4 例患者均处于 CFR<2 和 CACS>10 组。
CACS 与 HD 患者的 CFR 相关。然而，我们没有发现炎症与 CACS 和 CFR 之间有任何关联。CFR 与 CACS 之间的这种关联可能表明 HD 患者动脉系统的共同病理生理学存在两个不同的（解剖学和功能学）方面。
