Abstract 10961: Coronary Flow Reserve Predicts Cardiovascular and Cerebrovascular Events in Patients with Chronic Kidney Disease
Purpose: Coronary flow reserve (CFR) provides essential information about the coronary microvascular bed in the absence of epicardial coronary artery narrowing. The reduction of CFR may contribute to the development of myocardial ischemia in patients with normal coronary arteries. Chronic kidney disease (CKD) is a risk factor for cardiovascular and cerebrovascular diseases. We hypothesized that CFR is impaired in patients with CKD, who has no epicardial coronary artery stenosis, and CFR may be a useful predictor for cardiovascular and cerebrovascular events in patients with CKD.
Methods: Seventy-six patients with suspected coronary artery disease were examined for the assessment of CFR from the 1993 to the 2008 (mean age, 59±12 years). CKD was defined as estimated GFR of less than 60 ml/min/1.73m2 by the MDRD formula for Japanese. We excluded the patients with left ventricular ejection fraction of less than 50% and valvular diseases from this study. All of 76 patients had no significant epicardial coronary stenosis (>50%) by control coronary arteriography, and vasospasm was not induced by intracoronary acetylcholine administration. The average peak flow velocity (APV) of the mid left anterior descending coronary (LAD) artery was measured using the Doppler flow wire. Under maximal dilatation of the epicardial LAD by intracoronary injection of nitroglycerin and papaverine (12 mg), CFR was determined as the change of papaverine-mediated APV to control APV.
Results: There were no significant differences in age, BMI and ejection fraction and follow up period between CKD group and non-CKD group. CFR was significantly lower in the CKD group than in the non-CKD group (3.13±0.6 vs. 4.00±1.1, P<0.01). CKD group had a higher incidence of subsequent cardiovascular and cerebrovascular events than non-CKD group (30.8% vs. 9.5%, P <0.05). Importantly, in CKD group, CFR was significantly lower in patients with cardiovascular and cerebrovascular events than in those without events (2.59 ± 0.16 vs. 3.37 ± 0.51, P <0.05).
Conclusions: Our data suggest that coronary microvascular dysfunction is evident in CKD patients in the absence of epicardial coronary artery narrowing. CFR may be a promising predictor for cardiovascular and cerebrovascular events in CKD.
- © 2010 by American Heart Association, Inc.