Tebaldi Matteo, Biscaglia Simone, Fineschi Massimo, Manari Antonio, Menozzi Mila, Secco Gioel Gabrio, Di Lorenzo Emilio, D'Ascenzo Fabrizio, Fabbian Fabio, Tumscitz Carlo, Ferrari Roberto, Campo Gianluca
Cardiovascular Institute, Azienda Ospedaliero-Universitaria Di Ferrara, Cona, Ferrara, Italy.
Department of Cardiology, University Medical Hospital of Siena, Siena, Italy.
Catheter Cardiovasc Interv. 2016 Oct;88(4):555-562. doi: 10.1002/ccd.26364. Epub 2015 Dec 31.
To establish if the presence of chronic kidney disease (CKD) influences fractional flow reserve (FFR) value in patients with intermediate coronary stenosis.
FFR-guided coronary revascularization reduces cardiac adverse events in patients with coronary artery disease. CKD impairs microcirculation and increases cardiovascular risk. Whether CKD presence may limit FFR accuracy is unknown.
We used data from a multicenter prospective registry enrolling 1.004 patients undergoing FFR evaluation for intermediate stenosis. We assessed the relationship between clinical and angiographic variables and FFR measurement. CKD was defined as CrCl value ≤45 ml/min. FFR value was considered potentially flow-limiting, and therefore positive, if ≤0.80. The index of microcirculatory resistance (IMR) was calculated in 20 patients stratified according CrCl value (single-center substudy).
FFR measurement was positive in 395 (39%) patients. Overall, 131 (13%) patients had CKD. Patients with CrCl ≤45 ml/min showed significantly higher FFR values as compared to the others (0.84 ± 0.07 vs. 0.81 ± 0.08, p < 0.001). Positive FFR occurrence was lower in patients with CrCl ≤45 ml/min (27% vs. 41%, p < 0.01). After multivariable analysis, diabetes (HR 1.07, 95%CI 1.008-1.13, p = 0.03), left anterior descending (HR 1.35, 95%CI 1.27-1.43, p < 0.001) and CrCl ≤45 ml/min (HR 0.92, 95%CI 0.87-0.97, p = 0.005) emerged as independent predictors of FFR measurement. Accordingly, IMR values were higher in patients with CrCl ≤45 ml/min (32 U [28245] vs. 16 U [11220], p < 0.01).
FFR and IMR measurements differ between CKD patients and those with normal renal function. Flow-limiting FFR is less frequent in patients with CrCl ≤45 ml/min. © 2015 Wiley Periodicals, Inc.
确定慢性肾脏病（CKD）的存在是否会影响中度冠状动脉狭窄患者的血流储备分数（FFR）值。
FFR指导下的冠状动脉血运重建可降低冠心病患者的心脏不良事件。CKD会损害微循环并增加心血管风险。CKD的存在是否会限制FFR的准确性尚不清楚。
我们使用了一个多中心前瞻性注册研究的数据，该研究纳入了1004例因中度狭窄接受FFR评估的患者。我们评估了临床和血管造影变量与FFR测量值之间的关系。CKD定义为肌酐清除率（CrCl）值≤45 ml/min。如果FFR值≤0.80，则被认为可能存在血流限制，因此为阳性。在根据CrCl值分层的20例患者中计算了微循环阻力指数（IMR）（单中心子研究）。
395例（39%）患者的FFR测量值为阳性。总体而言，131例（13%）患者患有CKD。与其他患者相比，CrCl≤45 ml/min的患者FFR值明显更高（0.84±0.07 vs. 0.81±0.08，p<0.001）。CrCl≤45 ml/min的患者中FFR阳性的发生率较低（27% vs. 41%，p<0.01）。多变量分析后，糖尿病（HR 1.07，95%CI 1.008-1.13，p=0.03）、左前降支（HR
