Mild renal insufficiency is associated with reduced coronary flow in patients with non-obstructive coronary artery disease

Abstract

Patients with chronic kidney disease (CKD) have increased risk for cardiovascular events. However, the association between these pathophysiological processes is unclear. Therefore, this study was designed to determine the association between early CKD and coronary microvascular disease in patients with normal or mildly diseased coronary arteries. A total of 605 patients with normal or mildly diseased coronary arteries based on angiography underwent coronary flow reserve (CFR) evaluation using intracoronary adenosine. Patients were divided based on glomerular filtration rate (GFR). CKD was defined as calculated GFR<60 ml/min/1.73 m(2). Patients with normal GFR (> or =60 ml/min/1.73 m(2), n=481) had higher CFR compared to those with CKD (n=124, CFR=3.0+/-0.8 vs 2.6+/-0.6, P<0.001, respectively). Patients with abnormal GFR were more likely to be older and of female gender, with greater prevalence of hypertension. Multiple logistic regression analysis adjusted for the aforementioned risk factors further supported the observed relationship. The current study shows that reduced renal function is associated with attenuated coronary vasodilator capacity in patients without obstructive coronary artery disease. The correlation between low GFR and reduced CFR may suggest parallel alterations in the renal and coronary microcirculation at the early stage of disease. Impairment in both microcirculatory beds may reflect an unmeasured risk factor induced by blunted renal function and add a burden to the increased propensity for cardiovascular events in CKD.

Pediatric Myocardial Stunning Underscores the Cardiac Toxicity of Conventional Hemodialysis Treatments

“…They do, however, share a high prevalence of risk factors for adult-type cardiovascular disease (CVD) that have been associated with a reduced coronary flow reserve and thus a propensity to demand ischemia (20). Of these, hypertension, anemia, hyperparathyroidism, and hyperphosphatemia were significantly prevalent in our cohort.…”

Role of Nitric Oxide–Producing and–Degrading Pathways in Coronary Endothelial Dysfunction in Chronic Kidney Disease

“…Furthermore, coronary endothelial dysfunction is independently associated with the plasma ADMA concentration in men with early coronary atherosclerosis (32). Although reduced renal function is associated with attenuated coronary vasodilator capacity in patients with nonobstructive coronary artery disease (33), no investigation has examined the endothelial function of the coronary artery in CKD. We demonstrate that coronary endothelial dysfunction is already apparent in mild to moderate CKD, which endorses the recent findings that the risk for cardiovascular events is already high in patients with kidney disease and microalbuminuria (4).…”

Cardiac 82Rb PET/CT for fast and non-invasive assessment of microvascular function and structure in asymptomatic patients with type 2 diabetes

“…In individuals without epicardial coronary stenosis, cardiac PET can assess the function of the microcirculation, including the combined function of cells in the vascular smooth muscle and the endothelial cells. Among individuals without indications of CAD, microvascular dysfunction is associated with cardiovascular risk factors, including hypercholesterolaemia, diabetes, hypertension and smoking [7]. Moreover, it is a predictor of cardiac mortality [8].…”