title: Assessment of renal artery stenosis using both resting pressures ratio and fractional flow reserve: relationship to angiography and ultrasonography.
abstract: BACKGROUND. Clinical benefit from renal artery revascularization remains controversial, probably because of inaccurate stenosis severity assessment. Objective. The aim of the study was to evaluate resting translesional pressures ratio and renal fractional flow reserve (rFFR) in relation to angiography and Doppler duplex ultrasonography in patients with at least moderate renal artery stenosis (RAS). METHODS. 44 hypertensive patients (48% of males, mean age 65 years) with at least moderate RAS were investigated. Translesional systolic pressure gradient (TSPG), resting Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic rFFR - after intrarenal administration of papaverine - were evaluated. Quantitative angiographic analysis of stenosis severity was performed including minimal lumen diameter (MLD) and percent diameter stenosis (DS) assessment. Renal/aortic ratio (RAR), resistive index (RI) and deltaRI (side-to side difference) were obtained in Doppler-duplex ultrasonography. The predictive value of selected variables was calculated using receiver-operating characteristics curves. RESULTS. Mean Pd/Pa ratio was 0.86 ± 0.12 and decreased to 0.79 ± 0.13 after papaverine administration. Both Pd/Pa ratio and rFFR strongly correlated with TSPG (r = -0.92, p < 0.0001 and r = -0.88, p < 0.0001, respectively) and moderately with MLD (r = 0.62, p < 0.0001 and r = 0.66, p < 0.0001) and DS (r = -0.63, p < 0.0001 and r = -0.70, p < 0.0001). To identify more than 70% RAS, considered severe, the most predictive cut-off values were 0.93 for Pd/Pa ratio and 0.80 for rFFR. CONCLUSIONS. Mean Pd/Pa ratio and rFFR strongly correlated with angiographic data and in less pronounced manner with ultrasound parameters reflecting intrarenal blood flow. The best accuracy cut-off points for severe RAS predicting were 0.93 and 0.80, respectively.
authors.affiliation: Institute of Cardiology, Warsaw, Poland. kadziela@ikard.pl
authors.forename: Jacek
authors.initials: J
authors.lastname: Kadziela
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Cedro
authors.forename: Ilona
authors.initials: I
authors.lastname: Michałowska
authors.forename: Magdalena
authors.initials: M
authors.lastname: Januszewicz
authors.forename: Marek
authors.initials: M
authors.lastname: Kabat
authors.forename: Aleksander
authors.initials: A
authors.lastname: Prejbisz
authors.forename: Lukasz
authors.initials: L
authors.lastname: Kalińczuk
authors.forename: Piotr
authors.initials: P
authors.lastname: Zieleń
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Michel-Rowicka
authors.forename: Ewa
authors.initials: E
authors.lastname: Warchoł
authors.forename: Witold
authors.initials: W
authors.lastname: Rużyłło
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods