Evaluation of coronary microvascular function in patients with end-stage renal disease, and renal allograft recipients.
BACKGROUND
Approximately half of all deaths in patients with end-stage renal disease (ESRD) are due to cardiovascular diseases. Although renal transplant improves survival and quality of life in these patients, cardiovascular events significantly affect survival. We sought to evaluate coronary flow reserve (CFR), an indicator of coronary microvascular function, in patients with ESRD and in patients with a functioning kidney graft.


METHODS
Eighty-six patients (30 with ESRD, 30 with a functioning renal allograft, and 26 controls) free of coronary artery disease or diabetes mellitus were included. Transthoracic Doppler echocardiography was used to measure coronary peak flow velocities at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak flow velocities and was compared among the groups.


RESULTS
The mean age of the study population was 36.1+/-7.3 years. No between-group differences were found regarding age, sex, or prevalences of traditional coronary risk factors other than hypertension. Compared with the renal transplant and control groups, the ESRD group had significantly lower mean CFR values. On multivariate regression analysis, serum levels of creatinine, age, and diastolic dysfunction were independent predictors of CFR.


CONCLUSIONS
CFR is impaired in patients with ESRD suggesting that coronary microvascular dysfunction, an early finding of atherosclerosis, is evident in these patients. Although associated with a decreased CFR compared with controls, renal transplant on the other hand seems to have a favorable effect on coronary microvascular function.
Department of Cardiology, Faculty of Medicine, Baskent University, Ankara, Turkey. hbozbas@gmail.com
Huseyin
H
Bozbas
Bahar
B
Pirat
Saadet
S
Demirtas
Vahide
V
Simşek
Aylin
A
Yildirir
Elif
E
Sade
Burak
B
Sayin
Siren
S
Sezer
Hamdi
H
Karakayali
Haldun
H
Muderrisoglu
D000328:Adult; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D003326:Coronary Circulation; D003928:Diabetic Nephropathies / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D014184:Transplantation, Homologous; D055815:Young Adult