Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage

Charytan, David M.; Skali, Hicham; Shah, Nishant; Veeranna, Vikas; Cheezum, Michael K.; Taqueti, Viviany R.; Kato, Takashi; Bibbo, Courtney; Hainer, Jon; Dorbala, Sharmila; Blankstein, Ron; Carli, Marcelo F. Di

doi:10.1016/j.kint.2017.07.025

Cited by 71 publications

(70 citation statements)

References 46 publications

(52 reference statements)

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“…A hospital-based prospective study with 3,946 participants in the United States found that there was an inverse relationship between CKD stage and coronary flow reverse using positron emission tomography. 37 Uremia may lead to endothelial cell dropout or may cause angiogenesis to fail to occur as a compensatory response to ischemia, possibly because of destabilized hypoxia-inducible factor or the inhibition of nitric oxide synthase by asymmetric dimethylarginine. 38,39 In another pathway, elevated levels of asymmetric dimethyl arginine and other inhibitors of angiogenesis may lead to myocardial fibrosis and capillary rarefaction through endothelial-to-mesenchymal transformation; that is, the transformation of endothelial cells into fibroblasts.…”

Section: Discussionmentioning

confidence: 99%

Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study

Izumaru¹,

Hata

Nakano

et al. 2019

American Journal of Kidney Diseases

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Section: Discussionmentioning

confidence: 99%

Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study

Izumaru¹,

Hata

Nakano

et al. 2019

American Journal of Kidney Diseases

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“…CFR may be impaired in patients with significant stenoses of the epicardial coronary arteries, but also patients with microvascular dysfunction suggesting a decreased functional capacity of the microcirculation to adapt to the myocardium needs . Impaired CFR has been demonstrated in various populations at increased cardiovascular risk including patients with CKD and dialysis patients and carries significant both diagnostic (coronary artery disease) and prognostic value . A cutoff value of CFR >2.0 has been considered normal and associated with increased survival rates .…”

Section: Introductionmentioning

confidence: 99%

Impaired coronary microcirculation is associated with left ventricular diastolic dysfunction in end‐stage chronic kidney disease patients

et al. 2020

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Introduction: Coronary vascular dysfunction, as assessed by coronary flow reserve (CFR) in the left anterior descending coronary artery, is found in various conditions including end-stage chronic kidney disease (CKD). Currently, we investigated the associations of CFR with echocardiographic indices of systolic and diastolic cardiac function and identified independent predictors of CFR in hemodialysis patients. Methods: End-stage CKD patients treated with hemodialysis (n = 29) without known cardiovascular disease were recruited from a Hemodialysis Unit in Northwestern Greece. A thorough echocardiographic evaluation including CFR measurement following dipyridamole infusion was performed in all participants. Arterial stiffness was assessed by measurement of carotid-femoral pulse wave velocity and aortic augmentation index. Results: The mean age of the patients was 63 years, and mean duration of hemodialysis was 2.9 years. CFR was 1.60 ± 0.37 while dipyridamole caused a significant increase in E' sep , S lat , E' lat , and Stroke volume (P < .05 for all). Independent predictors of CFR were posterior wall thickness (B −0.408, P = .013) and dipyridamole-induced changes in Tei index (B −0.425, P = .007). A severely decreased CFR < 1.5 was observed in 52% of the patients. E/E' ratio (B 10.84, P = .014) was the single independent predictor of severely decreased CFR. Conclusions: In end-stage CKD patients on hemodialysis without known cardiovascular disease, impaired coronary vascular function was prevalent and related to increased left ventricular wall thickness, increased filling pressures, and dipyridamole-induced deteriorated myocardial function independently of the presence of wall-motion abnormalities. Further studies are required to clarify the prognostic role of dipyridamole-induced cardiac changes in hemodialysis patients. K E Y W O R D S coronary flow reserve, diastolic function, echocardiography, end-stage renal disease, left ventricular function | 537 PAPAMICHAIL et AL.

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“…The dynamic acquisition scan of 4 min 40 s was performed with corresponding frame times of (14 × 5 s, 3 × 10 s, 3 × 20 s, and 4 × 30 s). After a 10-min decay of the [ 15 Adenosine was initiated 2 min before the stress scan for maximal vasodilatation. The mean radiation dose was 1 mSv for the perfusion study.…”

Section: Myocardial Petmentioning

confidence: 99%

“…Decreased MPR has been also documented in several preatherosclerotic states like hypertension [10] and dyslipidemia [11] without obstructive CAD. Furthermore, reduced MPR has been established in patients with mild to severe CKD [12][13][14], and it is associated with CV mortality also in patients with CKD [15,16].…”

Section: Introductionmentioning

confidence: 99%

Myocardial perfusion reserve of kidney transplant patients is well preserved

et al. 2020

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Background: Chronic kidney disease (CKD) is associated with endothelial dysfunction and increased cardiovascular mortality. Endothelial dysfunction can be studied measuring myocardial perfusion reserve (MPR). MPR is the ratio of stress and rest myocardial perfusion (MP) and reflects the capacity of vascular bed to increase perfusion and microvascular responsiveness. In this pilot study, our aim was to assess MPR of 19 patients with kidney transplant (CKD stages 2-3) and of ten healthy controls with quantitative [ 15 O]H 2 O positron emission tomography (PET) method. Results: Basal MP was statistically significantly higher at rest in the kidney transplant patients than in the healthy controls [1.3 (0.4) ml/min/g and 1.0 (0.2) ml/min/g, respectively, p = 0.0015]. After correction of basal MP by cardiac workload [MP corr = basal MP/individual rate pressure product (RPP) × average RPP of the healthy controls], the difference between the groups disappeared [0.9 (0.2) ml/min/g and 1.0 (0.3) ml/min/g, respectively, p = 0.55)]. There was no difference in stress MP between the kidney transplant patients and the healthy subjects [3.8 (1.0) ml/min/g and 4.0 (0.9) ml/min/g, respectively, p = 0.53]. Although MPR was reduced, MPR corr (stress MP/basal MP corr ) did not differ between the kidney transplant patients and the healthy controls [4.1 (1.1) and 4.3 (1.6), respectively, p = 0.8].Conclusions: MP during stress is preserved in kidney transplant patients with CKD stage 2-3. The reduced MPR appears to be explained by increased resting MP. This is likely linked with increased cardiac workload due to sympathetic overactivation in kidney transplant patients.

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Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage

Cited by 71 publications

References 46 publications

Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study

Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study

Impaired coronary microcirculation is associated with left ventricular diastolic dysfunction in end‐stage chronic kidney disease patients

Myocardial perfusion reserve of kidney transplant patients is well preserved

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