Kadziela Jacek, Witkowski Adam, Januszewicz Andrzej, Cedro Krzysztof, Michałowska Ilona, Januszewicz Magdalena, Kabat Marek, Prejbisz Aleksander, Kalińczuk Lukasz, Zieleń Piotr, Michel-Rowicka Katarzyna, Warchoł Ewa, Rużyłło Witold
Institute of Cardiology, Warsaw, Poland.
Blood Press. 2011 Aug;20(4):211-7. doi: 10.3109/08037051.2011.558332. Epub 2011 Feb 10.
BACKGROUND. Clinical benefit from renal artery revascularization remains controversial, probably because of inaccurate stenosis severity assessment. Objective. The aim of the study was to evaluate resting translesional pressures ratio and renal fractional flow reserve (rFFR) in relation to angiography and Doppler duplex ultrasonography in patients with at least moderate renal artery stenosis (RAS). METHODS. 44 hypertensive patients (48% of males, mean age 65 years) with at least moderate RAS were investigated. Translesional systolic pressure gradient (TSPG), resting Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic rFFR - after intrarenal administration of papaverine - were evaluated. Quantitative angiographic analysis of stenosis severity was performed including minimal lumen diameter (MLD) and percent diameter stenosis (DS) assessment. Renal/aortic ratio (RAR), resistive index (RI) and deltaRI (side-to side difference) were obtained in Doppler-duplex ultrasonography. The predictive value of selected variables was calculated using receiver-operating characteristics curves. RESULTS. Mean Pd/Pa ratio was 0.86 ± 0.12 and decreased to 0.79 ± 0.13 after papaverine administration. Both Pd/Pa ratio and rFFR strongly correlated with TSPG (r = -0.92, p < 0.0001 and r = -0.88, p < 0.0001, respectively) and moderately with MLD (r = 0.62, p < 0.0001 and r = 0.66, p < 0.0001) and DS (r = -0.63, p < 0.0001 and r = -0.70, p < 0.0001). To identify more than 70% RAS, considered severe, the most predictive cut-off values were 0.93 for Pd/Pa ratio and 0.80 for rFFR. CONCLUSIONS. Mean Pd/Pa ratio and rFFR strongly correlated with angiographic data and in less pronounced manner with ultrasound parameters reflecting intrarenal blood flow. The best accuracy cut-off points for severe RAS predicting were 0.93 and 0.80, respectively.
背景。肾动脉血运重建的临床益处仍存在争议，可能是因为狭窄严重程度评估不准确。目的。本研究旨在评估至少中度肾动脉狭窄（RAS）患者静息跨病变压力比值和肾血流分数储备（rFFR）与血管造影和多普勒双功超声检查的关系。方法。对44例至少中度RAS的高血压患者（男性占48%，平均年龄65岁）进行研究。评估跨病变收缩压梯度（TSPG）、静息Pd/Pa比值（病变远端与近端平均压力之比）以及肾内注射罂粟碱后的充血性rFFR。进行了狭窄严重程度的定量血管造影分析，包括最小管腔直径（MLD）和直径狭窄百分比（DS）评估。在多普勒双功超声检查中获得肾/主动脉比值（RAR）、阻力指数（RI）和deltaRI（双侧差异）。使用受试者操作特征曲线计算选定变量的预测价值。结果。平均Pd/Pa比值为0.86±0.12，注射罂粟碱后降至0.79±0.13。Pd/Pa比值和rFFR均与TSPG密切相关（分别为r = -0.92，p < 0.0001和r = -0.88，p < 0.0001），与MLD中度相关（r = 0.62，p < 0.0001和r = 0.66，p < 0.0001），与DS中度相关（r = -0.63，p < 0.0001和r = -0.70，p < 0.0001）。为了识别超过70%的RAS（视为严重），Pd/Pa比值的最具预测性的截断值为0.93，rFFR为0.80。结论。平均Pd/Pa比值和rFFR与血管造影数据密切相关，与反映肾内血流的超声参数相关性较弱。预测严重RAS的最佳准确性截断点分别为0.93和0.80。
