Prognostic Value of Coronary Flow Reserve in Patients with Dialysis-Dependent ESRD

Capillary rarefaction of the coronary microcirculation is a consistent phenotype in patients with dialysis-dependent ESRD (dd-ESRD) and may help explain their excess mortality. Global coronary flow reserve (CFR) assessed by positron emission tomography (PET) is a noninvasive, quantitative marker of...

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Published in:Journal of the American Society of Nephrology 2016-06, Vol.27 (6), p.1823-1829
Main Authors: Shah, Nishant R, Charytan, David M, Murthy, Venkatesh L, Skali Lami, Hicham, Veeranna, Vikas, Cheezum, Michael K, Taqueti, Viviany R, Kato, Takashi, Foster, Courtney R, Hainer, Jon, Gaber, Mariya, Klein, Josh, Dorbala, Sharmila, Blankstein, Ron, Di Carli, Marcelo F
Format: Article
Language:English
Subjects:
Aged
Clinical Research
Coronary Circulation
Coronary Vessels - physiopathology
Female
Humans
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - physiopathology
Kidney Failure, Chronic - therapy
Male
Middle Aged
Prognosis
Renal Dialysis
Retrospective Studies
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Summary:Capillary rarefaction of the coronary microcirculation is a consistent phenotype in patients with dialysis-dependent ESRD (dd-ESRD) and may help explain their excess mortality. Global coronary flow reserve (CFR) assessed by positron emission tomography (PET) is a noninvasive, quantitative marker of myocardial perfusion and ischemia that integrates the hemodynamic effects of epicardial stenosis, diffuse atherosclerosis, and microvascular dysfunction. We tested whether global CFR provides risk stratification in patients with dd-ESRD. Consecutive patients with dd-ESRD clinically referred for myocardial perfusion PET imaging were retrospectively included, excluding patients with prior renal transplantation. Per-patient CFR was calculated as the ratio of stress to rest absolute myocardial blood flow. Multivariable Cox proportional hazards models, including age, overt cardiovascular disease, and myocardial scar/ischemia burden, were used to assess the independent association of global CFR with all-cause and cardiovascular mortality. The incremental value of global CFR was assessed with relative integrated discrimination index and net reclassification improvement. In 168 patients included, median global CFR was 1.4 (interquartile range, 1.2-1.8). During follow-up (median of 3 years), 36 patients died, including 21 cardiovascular deaths. Log-transformed global CFR independently associated with all-cause mortality (hazard ratio, 0.01 per 0.5-unit increase; 95% confidence interval,
ISSN:1046-6673
1533-3450
DOI:10.1681/ASN.2015030301