Increased basal myocardial perfusion in patients with chronic kidney disease without symptomatic coronary artery disease

Koivuviita, Niina; Tertti, Risto; Järvisalo, Mikko J.; Pietilä, Mikko; Hannukainen, Jarna C.; Sundell, Jan; Nuutila, Pirjo; Knuuti, Juhani; Metsärinne, Kaj

doi:10.1093/ndt/gfp175

Cited by 26 publications

(22 citation statements)

References 46 publications

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“…20 However, they found that differences in age and sex were largely responsible for the observed differences in CFR. A similar study by Koivuviita et al 21 in 21 CKD patients and 10 control subjects without signs or symptoms of CVD who underwent myocardial PET imaging also did not find a significant association between CFR and CKD, although there was a trend toward low CFR with more significant CKD. In contrast, a study using transthoracic echocardiography in a cohort of 10 dialysis patients and 14 matched control subjects with normal coronaries, found that both peak flow and CFR were below normal in 50% of the dialysis patients compared with only 5% of control patients.…”

Section: Discussionmentioning

confidence: 58%

Coronary Microvascular Function in Early Chronic Kidney Disease

Charytan

Shelbert

Carli

2010

Circ: Cardiovascular Imaging

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Background-Coronary microvascular dysfunction may underlie the high cardiovascular risk associated with chronic kidney disease (CKD), but the effects of CKD on coronary microvasculature function remain uncertain. Methods and Results-We assessed myocardial blood flow changes in mild-to-moderate CKD and analyzed the association between creatinine clearance (CrCl) and peak myocardial blood flow and coronary flow reserve (CFR) measured as the ratio of stress to rest perfusion at baseline and at 1 year in 435 nondiabetic individuals who underwent quantitative rest and pharmacological stress positron emission tomography imaging. At baseline, CFR was significantly associated with CrCl (␤ per 10 mL/min increase, 0.07; Pϭ0.001). Factors such as age and blood pressure accounted for this association, and it was not significant in adjusted analyses (␤ϭϪ0.02, Pϭ0.53). Peak flow was not associated with CrCl in either crude or adjusted analyses (␤ per 10 mL/minϭϪ0.02 mL/min per g, Pϭ0.29). Although change in peak flow at 1 year was similar in patients with and without CKD, CrCl was a strong and independent predictor of a higher rate of change in CFR, with a loss of 0.11 CFR units/y (95% confidence interval, 0.01 to 0.20) for each 10 mL/min drop in CrCl (Pϭ0.03). Conclusions-These findings demonstrate that mild-to-moderate CKD is not independently associated with a reduction in peak myocardial flow or CFR and suggests that microvascular changes are unlikely to explain the high cardiovascular mortality in mild to moderate CKD. Loss of CFR, however, may accelerate in mild to moderate CKD. Further studies are needed to determine whether these changes lead to more significant reductions that may reduce peak flows and CFR and contribute to cardiovascular risk in more severe CKD. (Circ Cardiovasc Imaging. 2010;3:663-671.)

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Section: Discussionmentioning

confidence: 58%

Coronary Microvascular Function in Early Chronic Kidney Disease

Charytan

Shelbert

Carli

2010

Circ: Cardiovascular Imaging

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“…Chade et al used coronary flow wires to measure mid left anterior descending artery coronary flow reserve in patients without significant coronary disease, and found no independent association between CKD and a low flow reserve (25). A similar study by Koivuviita et al, which included 31 individuals (21 with CKD) without cardiovascular disease who underwent myocardial positron emission tomography, also did not show a significant association between nuclear flow reserve and CKD (26). In the context of these prior investigations, our findings raise new questions about animal models that have consistently demonstrated microvascular dropout in the myocardium of uremic animals (17,(27)(28)(29).…”

Section: Discussionmentioning

confidence: 97%

CKD and Coronary Collateral Supply in Individuals Undergoing Coronary Angiography after Myocardial Infarction

Charytan

Stern

Mauri

2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives CKD patients have high mortality risk after myocardial infarction (MI). An adequate supply of coronary collaterals to the culprit vessel responsible for MI is associated with reduced risks of death and complications. Whether a diminished supply of collaterals contributes to the high risk in CKD patients is uncertain.Design, setting, participants, & measurements Quantitative coronary angiography was performed in a consecutive series of individuals with (n=58) and without (n=165) CKD (estimated GFR ,60 ml/min per 1.73 m 2 ) who underwent coronary angiography at the time of MI. Collateral supply was analyzed and candidate predictors were assessed in patient-level and individual artery-level models using logistic regression and ordered categorical regression, respectively.Results There were no significant differences in collateral supply among 58 CKD patients and 165 individuals with preserved renal function. Culprit artery collaterals were present in 25.0% of CKD patients compared with 27.2% of individuals with preserved renal function (P=0.76). The odds of having an adequate supply of culprit vessel collaterals were also not significantly different in individuals with and without CKD, respectively. CKD patients were 2.22-fold more likely to have visible collaterals to the nonculprit vessels in unadjusted analyses. The difference was not significant after correction for percent stenosis and comorbid factors.Conclusions Our results do not support an independent association between CKD and diminished collateral supply to either the culprit or nonculprit vessels in MI. Additional studies are warranted to better define associations between myocardial capillary supply, collateral supply, and the full range of human CKD.

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“…Their study enrolled patients with various stages of CKD but at relatively small numbers. No specific exclusion of subjects with regional perfusion abnormality was performed, although the contribution of macroscopic disease and ischemia was probably low because of lack of decreased stress flow (30).…”

Section: Discussionmentioning

confidence: 99%

Impaired Global Myocardial Flow Dynamics Despite Normal Left Ventricular Function and Regional Perfusion in Chronic Kidney Disease: A Quantitative Analysis of Clinical ⁸²Rb PET/CT Studies

Fukui¹,

Javadi

Higuchi

et al. 2012

J Nucl Med

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Impaired global myocardial flow reserve (MFR) may be associated with increased risk for cardiac events and coronary artery disease progression. Chronic kidney disease (CKD) is also considered a risk factor for cardiovascular disease. We sought to investigate the effect of CKD on the myocardial microcirculation in patients referred for clinical 82 Rb PET/CT, who had normal left ventricular (LV) function and no flow-limiting coronary artery disease. Methods: Estimated glomerular filtration rate (eGFR) was available for 230 patients who had undergone rest and pharmacologic stress 82 Rb PET/CT for suspected coronary artery disease. CKD was defined as an eGFR less than 60 mL/min/1.73 m 2 . After patients with hemodialysis, a renal transplant, abnormal regional perfusion (summed stress score . 4), or reduced LV function (LV ejection fraction , 45%) were excluded, 40 CKD patients remained. Those were compared with a control group without CKD, which was matched for age, sex, coronary risk factors, and systemic hemodynamics (n 5 42). List-mode acquisition of PET enabled quantification of myocardial blood flow (MBF) and MFR using a previously validated retention model with correction for 82 Rb extraction. Rest MBF was normalized to rate-pressure product. Results: Mean eGFR in the CKD group was reduced (44 6 14 vs. 99 6 28 mL/min/ 1.73 m 2 ; P , 0.0001), and creatinine was significantly elevated, compared with controls (1.9 6 1.1 vs. 0.8 6 0.2 mg/dL; P , 0.0001). MFR was significantly reduced in CKD (2.2 6 1.0 vs. 3.0 6 1.2 for controls; P 5 0.027). This reduction was mainly due to increased rest MBF (1.1 6 0.4 in CKD vs. 0.8 6 0.2 mL/ min/g in controls; P 5 0.007). Stress myocardial flow was comparable between both groups (2.3 6 0.9 vs. 2.3 6 0.8 mL/min/g; P 5 0.08). Overall, MFR was significantly correlated with eGFR (r 5 0.41; P 5 0.0005). Stress MBF did not correlate with eGFR (r 5 0.002; P 5 0.45), but rest MBF showed an inverse correlation (r 5 20.49; P , 0.0001). Rest MBF was also inversely correlated with hemoglobin (r 5 20.28; P 5 0.014), but only eGFR was an independent correlate at multivariate analysis.Conclusion: MFR is impaired in patients with renal insufficiency with normal regional perfusion and LV function, mostly because of elevated rest flow. Absolute quantification of flow may be useful to identify microvascular dysfunction as a precursor of clinically overt coronary disease in this specific risk group.

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Increased basal myocardial perfusion in patients with chronic kidney disease without symptomatic coronary artery disease

Cited by 26 publications

References 46 publications

Coronary Microvascular Function in Early Chronic Kidney Disease

Coronary Microvascular Function in Early Chronic Kidney Disease

CKD and Coronary Collateral Supply in Individuals Undergoing Coronary Angiography after Myocardial Infarction

Impaired Global Myocardial Flow Dynamics Despite Normal Left Ventricular Function and Regional Perfusion in Chronic Kidney Disease: A Quantitative Analysis of Clinical ⁸²Rb PET/CT Studies

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Increased basal myocardial perfusion in patients with chronic kidney disease without symptomatic coronary artery disease

Cited by 26 publications

References 46 publications

Coronary Microvascular Function in Early Chronic Kidney Disease

Coronary Microvascular Function in Early Chronic Kidney Disease

CKD and Coronary Collateral Supply in Individuals Undergoing Coronary Angiography after Myocardial Infarction

Impaired Global Myocardial Flow Dynamics Despite Normal Left Ventricular Function and Regional Perfusion in Chronic Kidney Disease: A Quantitative Analysis of Clinical 82Rb PET/CT Studies

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Impaired Global Myocardial Flow Dynamics Despite Normal Left Ventricular Function and Regional Perfusion in Chronic Kidney Disease: A Quantitative Analysis of Clinical ⁸²Rb PET/CT Studies