title: Prognostic value of renal fractional flow reserve in blood pressure response after renal artery stenting (PREFER study).
abstract: BACKGROUND
  The aim of our study was to determine a potential relationship between resting translesional pressures ratio (Pd/Pa ratio), renal fractional flow reserve (rFFR) and blood pressure response after renal artery stenting.
  
  
  METHODS
  Thirty five hypertensive patients (49% males, mean age 64 years) with at least 60% stenosis in angiography, underwent renal artery stenting. Translesional systolic pressure gradient (TSPG), Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic rFFR - after intrarenal administration of papaverine - were measured before stent implantation. Ambulatory blood pressure measurements (ABPM) were recorded before the procedure and after 6 months. The ABPM results were presented as blood pressure changes in subgroups of patients with normal (≥ 0.9) vs. abnormal (< 0.9) Pd/Pa ratio and normal (≥ 0.8) vs. abnormal (< 0.8) rFFR.
  
  
  RESULTS
  Median Pd/Pa ratio was 0.84 (interquartile range 0.79-0.91) and strongly correlated with TSPG (r = -0.89, p < 0.001), minimal lumen diameter (MLD; r = 0.53, p < 0.005) and diameter stenosis (DS; r = -0.51, p < 0.005). Median rFFR was 0.78 (0.72-0.82). Similarly, significant correlation between rFFR and TSPG (r = -0.86, p < 0.0001), as well as with MLD (r = 0.50, p < 0.005) and DS (r = -0.51, p < 0.005) was observed. Procedural success was obtained in all patients. Baseline Pd/Pa ratio and rFFR did not predict hypertension response after renal artery stenting. Median changes of 24-h systolic/diastolic blood pressure were comparable in patients with abnormal vs. normal Pd/Pa ratio (-4/-3 vs. 0/2 mm Hg; p = NS) and with abnormal vs. normal rFFR (-2/-1 vs. -2/-0.5 mm Hg, respectively).
  
  
  CONCLUSIONS
  Physiological assessment of renal artery stenosis using Pd/Pa ratio and papaverine- induced renal fractional fl ow reserve did not predict hypertension response after renal artery stenting.
authors.affiliation: Institute of Cardiology, Warsaw, Poland. kadziela@ikard.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kądziela
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
authors.forename: Aleksander
authors.initials: A
authors.lastname: Prejbisz
authors.forename: Ilona
authors.initials: I
authors.lastname: Michałowska
authors.forename: Magdalena
authors.initials: M
authors.lastname: Januszewicz
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Florczak
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Kalińczuk
authors.forename: Bożena
authors.initials: B
authors.lastname: Norwa-Otto
authors.forename: Ewa
authors.initials: E
authors.lastname: Warchoł
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010208:Papaverine; D011237:Predictive Value of Tests; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012079:Renal Circulation; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D010208:Papaverine