Impact of Kidney Function on Physiological Assessment of Coronary Circulation.

IF 1.9 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Reviews in cardiovascular medicine Pub Date : 2024-10-08 eCollection Date: 2024-10-01 DOI:10.31083/j.rcm2510358
Wojciech Zasada, Barbara Zdzierak, Tomasz Rakowski, Beata Bobrowska, Agata Krawczyk-Ożóg, Sławomir Surowiec, Stanisław Bartuś, Andrzej Surdacki, Artur Dziewierz
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Abstract

Background: 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.

Methods: 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 m2) and GFR-H (eGFR ≥70 mL/min/1.73 m2).

Results: 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 m2 was the optimal cut-off to differentiate patients concerning the mentioned discrepancies.

Conclusions: Kidney function influenced the coronary circulation physiological assessment results. Patients with reduced eGFR tended to have negative hyperemic assessments, especially in non-LAD vessels.

肾功能对冠状动脉循环生理评估的影响
背景: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)是导致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:方法:从克拉科夫大学医院心脏病学和心血管介入临床部连续收治的 279 名患者中收集数据。共对 417 根血管进行了分数血流储备(FFR)和非血压静息压力比(如瞬时无波比(iFR)和静息全周期比(RFR))评估。患者被分为两组:肾小球滤过率(GFR)-L(估计GFR(eGFR)2)和GFR-H(eGFR≥70 mL/min/1.73 m2):共有 118 名患者(42.3%)被纳入 GFR-L 组,161 名患者(57.7%)被纳入 GFR-H 组。在大约 60% 的手术中,左冠状动脉(LAD)的左前降支是被评估的血管,这在两个研究组中的频率非常相似。仅就 LAD 评估而言,两组的 FFR 指标(连续指标和二元指标)相当。相反,对于非左上动脉血管,GFR-H 组的 FFR 值大幅降低,更多血管出现明显收缩。与 eGFR 值较低的患者相比,GFR-H 组患者出现 FFR+ | iFR/RFR- 差异的情况更多。eGFR 为 70 mL/min/1.73 m2 是区分上述差异患者的最佳临界值:结论:肾功能影响冠状动脉循环生理评估结果。结论:肾功能对冠状动脉循环生理评估结果有影响。eGFR降低的患者往往有负面的高充血评估,尤其是在非左冠状动脉血管。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Reviews in cardiovascular medicine
Reviews in cardiovascular medicine 医学-心血管系统
CiteScore
2.70
自引率
3.70%
发文量
377
审稿时长
1 months
期刊介绍: RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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