Zasada Wojciech, Zdzierak Barbara, Rakowski Tomasz, Bobrowska Beata, Krawczyk-Ożóg Agata, Surowiec Sławomir, Bartuś Stanisław, Surdacki Andrzej, Dziewierz Artur
Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland.
KCRI, 30-347 Krakow, Poland.
Rev Cardiovasc Med. 2024 Oct 8;25(10):358. doi: 10.31083/j.rcm2510358. eCollection 2024 Oct.
Diagnosing myocardial ischemia in chronic kidney disease (CKD) patients is crucial since coronary artery disease (CAD) forms the predominant cause of mortality in these patients. Thus, this study aimed to assess the impact of kidney function on the results of coronary circulation physiological assessment.
Data were collected from 279 consecutive patients admitted to the Clinical Department of Cardiology and Cardiovascular Interventions at the University Hospital in Krakow. A total of 417 vessels were assessed for fractional flow reserve (FFR) and non-hyperemic resting pressure ratios, such as instantaneous wave-free ratio (iFR) and resting full-cycle ratio (RFR). Patients were categorized into two groups: glomerular filtration rate (GFR)-L (estimated GFR (eGFR) <70 mL/min/1.73 m) and GFR-H (eGFR ≥70 mL/min/1.73 m).
A total of 118 patients (42.3%) were included in the GFR-L group, while 161 patients (57.7%) were in the GFR-H group. The left anterior descending branch of the left coronary artery (LAD) was the assessed vessel in approximately 60% of procedures, the frequency of which was very similar in both study groups. Focusing solely on LAD assessments, both FFR metrics (continuous and binary) were comparable between the groups. In contrast, for non-LAD vessels, the GFR-H group revealed substantially reduced FFR values, with more vessels displaying significant constriction. Patients in the GFR-H group showed higher instances of FFR+ iFR/RFR- discrepancies than their lower eGFR counterparts. An eGFR of 70 mL/min/1.73 m was the optimal cut-off to differentiate patients concerning the mentioned discrepancies.
Kidney function influenced the coronary circulation physiological assessment results. Patients with reduced eGFR tended to have negative hyperemic assessments, especially in non-LAD vessels.
诊断慢性肾脏病（CKD）患者的心肌缺血至关重要，因为冠状动脉疾病（CAD）是这些患者死亡的主要原因。因此，本研究旨在评估肾功能对冠状动脉循环生理评估结果的影响。
收集了克拉科夫大学医院心血管内科和心血管介入临床科室连续收治的279例患者的数据。共评估了417支血管的血流储备分数（FFR）和非充血状态下的静息压力比值，如瞬时无波比值（iFR）和静息全周期比值（RFR）。患者被分为两组：肾小球滤过率（GFR）-L组（估计肾小球滤过率（eGFR）<70 mL/min/1.73 m²）和GFR-H组（eGFR≥70 mL/min/1.73 m²）。
GFR-L组共纳入118例患者（42.3%），GFR-H组有161例患者（57.7%）。在大约60%的手术中，评估的血管为左冠状动脉前降支（LAD），两个研究组中该血管的评估频率非常相似。仅关注LAD评估时，两组间的FFR指标（连续型和二分法）具有可比性。相比之下，对于非LAD血管，GFR-H组的FFR值显著降低，更多血管表现出明显狭窄。GFR-H组患者出现FFR+iFR/RFR-差异的情况比eGFR较低的患者更多。eGFR为70 mL/min/1.73 m²是区分上述差异患者的最佳临界值。
肾功能影响冠状动脉循环生理评估结果。eGFR降低的患者往往有充血状态下的阴性评估结果，尤其是在非LAD血管中。
