Department of Interventional Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania -
Department of Interventional Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania.
Minerva Cardioangiol. 2020 Jun;68(3):261-267. doi: 10.23736/S0026-4725.20.05103-8. Epub 2020 Feb 25.
Renal dysfunction, an important predictor of cardiovascular mortality, is paradoxically associated with a lower incidence of positive coronary fractional flow reserve (FFR) values, possibly due to renal disease-associated myocardial microvascular dysfunction. It is unknown if this relationship is influenced by arterial hypertension, a condition strongly associated with renal- and microvascular dysfunction.
The incidence of positive (<0.81) FFR values was retrospectively evaluated in consecutive patients with intermediate severity coronary artery lesions that were either associating or not associating renal dysfunction (creatinine clearance, CrCl <90 mL/min/1.73 m2), and had mild/moderate or severe arterial hypertension (treated by <3 or ≥3 different drugs).
Positive FFR values were found in 49.5% of the 109 included patients, with a significantly lower incidence in those with renal dysfunction: 23 vs. 31 cases (39.7% vs. 60.8%, P=0.03). However, uni- and multivariate subpopulation analysis evidenced that renal dysfunction was a significant independent predictor of fewer positive FFR results only in severely hypertensive patients (univariate P values for mild/moderate and severe hypertension: 0.80 and <0.01, respectively; multivariate P in severely hypertensive patients: 0.04). This categorization significantly restricted the number of borderline FFR results (0.75-0.80) where measurement interpretation could be challenging because of renal dysfunction (from 13.8% to 4.6% of the whole study population, P=0.03).
In the current study renal dysfunction was independently associated with a significantly higher incidence of negative FFR results in patients with intermediate severity coronary artery lesions only in the presence of severe arterial hypertension. This observation should be confirmed by large-scale prospective clinical trials.
肾功能障碍是心血管死亡率的一个重要预测因素，但令人费解的是，它与正向的冠状动脉血流储备分数（FFR）值的发生率较低有关，这可能是由于与肾脏疾病相关的心肌微血管功能障碍所致。目前尚不清楚这种关系是否受到动脉高血压的影响，因为动脉高血压与肾功能和微血管功能障碍密切相关。
回顾性评估了 109 例连续中度严重冠状动脉病变患者的正向 FFR 值（<0.81）的发生率，这些患者要么伴有肾功能障碍（肌酐清除率 CrCl <90 mL/min/1.73 m2），要么不伴有肾功能障碍，且患者的动脉高血压为轻度/中度或重度（用 <3 种或 ≥3 种不同药物治疗）。
109 例患者中，有 49.5%的患者出现正向 FFR 值，伴有肾功能障碍的患者发生率明显较低：23 例与 31 例（39.7%与 60.8%，P=0.03）。然而，单因素和多因素亚组分析表明，肾功能障碍仅在重度高血压患者中是正向 FFR 结果较少的独立预测因素（轻度/中度和重度高血压的单因素 P 值分别为 0.80 和<0.01，重度高血压患者的多因素 P 值为 0.04）。这种分类显著减少了由于肾功能障碍而导致 FFR 测量结果解读具有挑战性的边界 FFR 结果（从整个研究人群的 13.8%到 4.6%，P=0.03）。
在目前的研究中，在中度严重冠状动脉病变患者中，仅在存在严重动脉高血压的情况下，肾功能障碍与显著更高的负向 FFR 结果发生率独立相关。这一观察结果应通过大规模前瞻性临床试验加以证实。
