Department of Cardiology, UMC Utrecht, The Netherlands.
BMC Cardiovasc Disord. 2012 Sep 18;12:76. doi: 10.1186/1471-2261-12-76.
Atherosclerotic renal artery stenosis (ARAS) is common in cardiovascular diseases and associated with hypertension, renal dysfunction and/or heart failure. There is a paucity of data about the prevalence and the role of ARAS in the pathophysiology of combined chronic heart failure (CHF) and chronic kidney disease (CKD). We investigated the prevalence in patients with combined CHF/CKD and its association with renal function, cardiac dysfunction and the presence and extent of myocardial fibrosis.
The EPOCARES study (ClinTrialsNCT00356733) investigates the role of erythropoietin in anaemic patients with combined CHF/CKD. Eligible subjects underwent combined cardiac magnetic resonance imaging (cMRI), including late gadolinium enhancement, with magnetic resonance angiography of the renal arteries (MRA).
MR study was performed in 37 patients (median age 74 years, eGFR 37.4 ± 15.6 ml/min, left ventricular ejection fraction (LVEF) 43.3 ± 11.2%), of which 21 (56.8%) had ARAS (defined as stenosis >50%). Of these 21 subjects, 8 (21.6%) had more severe ARAS >70% and 8 (21.6%) had a bilateral ARAS >50% (or previous bilateral PTA). There were no differences in age, NT-proBNP levels and medication profile between patients with ARAS versus those without. Renal function declined with the severity of ARAS (p = 0.03), although this was not significantly different between patients with ARAS versus those without. Diabetes mellitus was more prevalent in patients without ARAS (56.3%) against those with ARAS (23.8%) (p = 0.04). The presence and extent of late gadolinium enhancement, depicting myocardial fibrosis, did not differ (p = 0.80), nor did end diastolic volume (p = 0.60), left ventricular mass index (p = 0.11) or LVEF (p = 0.15). Neither was there a difference in the presence of an ischemic pattern of late enhancement in patients with ARAS versus those without.
ARAS is prevalent in combined CHF/CKD and its severity is associated with a decline in renal function. However, its presence does not correlate with a worse LVEF, a higher left ventricular mass or with the presence and extent of myocardial fibrosis. Further research is required for the role of ARAS in the pathophysiology of combined chronic heart and renal failure.
动脉粥样硬化性肾动脉狭窄（ARAS）在心血管疾病中很常见，与高血压、肾功能障碍和/或心力衰竭有关。关于 ARAS 在合并慢性心力衰竭（CHF）和慢性肾脏病（CKD）的病理生理学中的患病率及其作用的数据很少。我们研究了合并 CHF/CKD 患者的患病率及其与肾功能、心脏功能障碍以及心肌纤维化的存在和程度的关系。
EPOCARES 研究（ClinTrialsNCT00356733）调查了贫血合并 CHF/CKD 患者中促红细胞生成素的作用。符合条件的受试者接受了包括钆延迟增强在内的心脏磁共振成像（cMRI），并进行了肾动脉磁共振血管造影（MRA）。
37 名患者（中位年龄 74 岁，eGFR37.4±15.6ml/min，左心室射血分数（LVEF）43.3±11.2%）进行了 MR 研究，其中 21 名（56.8%）患有 ARAS（定义为狭窄>50%）。在这 21 名患者中，8 名（21.6%）患有更严重的 ARAS>70%，8 名（21.6%）患有双侧 ARAS>50%（或之前的双侧 PTA）。ARAS 患者与无 ARAS 患者的年龄、NT-proBNP 水平和药物治疗方案无差异。ARAS 患者的肾功能随 ARAS 严重程度下降（p=0.03），但与无 ARAS 患者相比，差异无统计学意义。无 ARAS 患者的糖尿病患病率（56.3%）高于有 ARAS 患者（23.8%）（p=0.04）。心肌纤维化的晚期钆增强程度（p=0.80）、舒张末期容积（p=0.60）、左心室质量指数（p=0.11）或 LVEF（p=0.15）均无差异。ARAS 患者与无 ARAS 患者的晚期增强缺血模式的存在也无差异。
ARAS 在合并 CHF/CKD 中很常见，其严重程度与肾功能下降有关。然而，它的存在与较低的 LVEF、较高的左心室质量或心肌纤维化的存在和程度无关。需要进一步研究 ARAS 在合并慢性心脏和肾功能衰竭的病理生理学中的作用。
