Matteo Tebaldi1, Simone Biscaglia2, Massimo Fineschi3, Antonio Manari4, Mila Menozzi5, Gioel Gabrio Secco6, Emilio Di Lorenzo7, Fabrizio D'Ascenzo8, Fabio Fabbian9, Carlo Tumscitz2, Roberto Ferrari2,10, Gianluca Campo2,11. 1. Cardiovascular Institute, Azienda Ospedaliero-Universitaria Di Ferrara, Cona, Ferrara, Italy. tblmtt@unife.it. 2. Cardiovascular Institute, Azienda Ospedaliero-Universitaria Di Ferrara, Cona, Ferrara, Italy. 3. Department of Cardiology, University Medical Hospital of Siena, Siena, Italy. 4. Department of Cardiology, Santa Maria Nuova Hospital, Reggio-Emilia, Italy. 5. Department of Cardiology, Ospedale Degli Infermi, Rimini. 6. Division of Cardiology, "Santi Antonio E Biagio E Cesare Arrigo" Hospital, Alessandria, Italy. 7. Department of Heart and Vessels, S.G. Moscati Hospital, Avellino, Italy. 8. Division of Cardiology Città Della Salute E Della Scienza, Hospital University of Turin, Turin, Italy. 9. Clinica Medica, Departement of Medical Science, University of Ferrara, Cona, Ferrara, Italy. 10. Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy. 11. Laboratorio per Le Tecnologie Delle Terapie Avanzate (LTTA) Center, Ferrara, Italy.
Abstract
OBJECTIVES: To establish if the presence of chronic kidney disease (CKD) influences fractional flow reserve (FFR) value in patients with intermediate coronary stenosis. BACKGROUND: FFR-guided coronary revascularization reduces cardiac adverse events in patients with coronary artery disease. CKD impairs microcirculation and increases cardiovascular risk. Whether CKD presence may limit FFR accuracy is unknown. METHODS: We used data from a multicenter prospective registry enrolling 1.004 patients undergoing FFR evaluation for intermediate stenosis. We assessed the relationship between clinical and angiographic variables and FFR measurement. CKD was defined as CrCl value ≤45 ml/min. FFR value was considered potentially flow-limiting, and therefore positive, if ≤0.80. The index of microcirculatory resistance (IMR) was calculated in 20 patients stratified according CrCl value (single-center substudy). RESULTS: FFR measurement was positive in 395 (39%) patients. Overall, 131 (13%) patients had CKD. Patients with CrCl ≤45 ml/min showed significantly higher FFR values as compared to the others (0.84 ± 0.07 vs. 0.81 ± 0.08, p < 0.001). Positive FFR occurrence was lower in patients with CrCl ≤45 ml/min (27% vs. 41%, p < 0.01). After multivariable analysis, diabetes (HR 1.07, 95%CI 1.008-1.13, p = 0.03), left anterior descending (HR 1.35, 95%CI 1.27-1.43, p < 0.001) and CrCl ≤45 ml/min (HR 0.92, 95%CI 0.87-0.97, p = 0.005) emerged as independent predictors of FFR measurement. Accordingly, IMR values were higher in patients with CrCl ≤45 ml/min (32 U [28245] vs. 16 U [11220], p < 0.01). CONCLUSIONS: FFR and IMR measurements differ between CKD patients and those with normal renal function. Flow-limiting FFR is less frequent in patients with CrCl ≤45 ml/min.
OBJECTIVES: To establish if the presence of chronic kidney disease (CKD) influences fractional flow reserve (FFR) value in patients with intermediate coronary stenosis. BACKGROUND: FFR-guided coronary revascularization reduces cardiac adverse events in patients with coronary artery disease. CKD impairs microcirculation and increases cardiovascular risk. Whether CKD presence may limit FFR accuracy is unknown. METHODS: We used data from a multicenter prospective registry enrolling 1.004 patients undergoing FFR evaluation for intermediate stenosis. We assessed the relationship between clinical and angiographic variables and FFR measurement. CKD was defined as CrCl value ≤45 ml/min. FFR value was considered potentially flow-limiting, and therefore positive, if ≤0.80. The index of microcirculatory resistance (IMR) was calculated in 20 patients stratified according CrCl value (single-center substudy). RESULTS: FFR measurement was positive in 395 (39%) patients. Overall, 131 (13%) patients had CKD. Patients with CrCl ≤45 ml/min showed significantly higher FFR values as compared to the others (0.84 ± 0.07 vs. 0.81 ± 0.08, p < 0.001). Positive FFR occurrence was lower in patients with CrCl ≤45 ml/min (27% vs. 41%, p < 0.01). After multivariable analysis, diabetes (HR 1.07, 95%CI 1.008-1.13, p = 0.03), left anterior descending (HR 1.35, 95%CI 1.27-1.43, p < 0.001) and CrCl ≤45 ml/min (HR 0.92, 95%CI 0.87-0.97, p = 0.005) emerged as independent predictors of FFR measurement. Accordingly, IMR values were higher in patients with CrCl ≤45 ml/min (32 U [28245] vs. 16 U [11220], p < 0.01). CONCLUSIONS: FFR and IMR measurements differ between CKD patients and those with normal renal function. Flow-limiting FFR is less frequent in patients with CrCl ≤45 ml/min.
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