Institute of Cardiology, Warsaw, Poland.
Cardiol J. 2013;20(4):418-22. doi: 10.5603/CJ.2013.0101.
The aim of our study was to determine a potential relationship between resting translesional pressures ratio (Pd/Pa ratio), renal fractional flow reserve (rFFR) and blood pressure response after renal artery stenting.
Thirty five hypertensive patients (49% males, mean age 64 years) with at least 60% stenosis in angiography, underwent renal artery stenting. Translesional systolic pressure gradient (TSPG), Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic rFFR - after intrarenal administration of papaverine - were measured before stent implantation. Ambulatory blood pressure measurements (ABPM) were recorded before the procedure and after 6 months. The ABPM results were presented as blood pressure changes in subgroups of patients with normal (≥ 0.9) vs. abnormal (< 0.9) Pd/Pa ratio and normal (≥ 0.8) vs. abnormal (< 0.8) rFFR.
Median Pd/Pa ratio was 0.84 (interquartile range 0.79-0.91) and strongly correlated with TSPG (r = -0.89, p < 0.001), minimal lumen diameter (MLD; r = 0.53, p < 0.005) and diameter stenosis (DS; r = -0.51, p < 0.005). Median rFFR was 0.78 (0.72-0.82). Similarly, significant correlation between rFFR and TSPG (r = -0.86, p < 0.0001), as well as with MLD (r = 0.50, p < 0.005) and DS (r = -0.51, p < 0.005) was observed. Procedural success was obtained in all patients. Baseline Pd/Pa ratio and rFFR did not predict hypertension response after renal artery stenting. Median changes of 24-h systolic/diastolic blood pressure were comparable in patients with abnormal vs. normal Pd/Pa ratio (-4/-3 vs. 0/2 mm Hg; p = NS) and with abnormal vs. normal rFFR (-2/-1 vs. -2/-0.5 mm Hg, respectively).
Physiological assessment of renal artery stenosis using Pd/Pa ratio and papaverine- induced renal fractional fl ow reserve did not predict hypertension response after renal artery stenting.
我们研究的目的是确定静息跨病变压力比（Pd/Pa 比值）、肾血流储备分数（rFFR）与肾动脉支架置入术后血压反应之间的潜在关系。
35 例高血压患者（男性占 49%，平均年龄 64 岁），其血管造影狭窄程度至少为 60%，行肾动脉支架置入术。在支架植入前，测量跨病变收缩期压力梯度（TSPG）、Pd/Pa 比值（病变远端和近端平均压力的比值）和罂粟碱后肾高血流 rFFR。在术前和术后 6 个月记录动态血压测量（ABPM）结果。ABPM 结果以正常（≥0.9）与异常（<0.9）Pd/Pa 比值和正常（≥0.8）与异常（<0.8）rFFR 患者亚组的血压变化呈现。
中位 Pd/Pa 比值为 0.84（四分位距 0.79-0.91），与 TSPG（r=-0.89，p<0.001）、最小管腔直径（MLD；r=0.53，p<0.005）和直径狭窄（DS；r=-0.51，p<0.005）强烈相关。中位 rFFR 为 0.78（0.72-0.82）。同样，rFFR 与 TSPG（r=-0.86，p<0.0001）以及 MLD（r=0.50，p<0.005）和 DS（r=-0.51，p<0.005）之间也存在显著相关性。所有患者均获得了手术成功。支架置入术前的 Pd/Pa 比值和 rFFR 均不能预测肾动脉支架置入后的高血压反应。Pd/Pa 比值异常与正常患者（-4/-3 与 0/2mmHg；p=NS）以及 rFFR 异常与正常患者（-2/-1 与-2/-0.5mmHg）相比，24 小时收缩压/舒张压的中位变化相当。
使用 Pd/Pa 比值和罂粟碱诱导的肾血流储备分数对肾动脉狭窄进行生理评估并不能预测肾动脉支架置入术后的高血压反应。
