Document Detail


Coronary microvascular function in early chronic kidney disease.
MedLine Citation:
PMID:  20851872     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: coronary microvascular dysfunction may underlie the high cardiovascular risk associated with chronic kidney disease (CKD), but the effects of CKD on coronary microvasculature function remain uncertain.
METHODS AND RESULTS: we assessed myocardial blood flow changes in mild-to-moderate CKD and analyzed the association between creatinine clearance (CrCl) and peak myocardial blood flow and coronary flow reserve (CFR) measured as the ratio of stress to rest perfusion at baseline and at 1 year in 435 nondiabetic individuals who underwent quantitative rest and pharmacological stress positron emission tomography imaging. At baseline, CFR was significantly associated with CrCl (β per 10 mL/min increase, 0.07; P=0.001). Factors such as age and blood pressure accounted for this association, and it was not significant in adjusted analyses (β=-0.02, P=0.53). Peak flow was not associated with CrCl in either crude or adjusted analyses (β per 10 mL/min=-0.02 mL/min per g, P=0.29). Although change in peak flow at 1 year was similar in patients with and without CKD, CrCl was a strong and independent predictor of a higher rate of change in CFR, with a loss of 0.11 CFR units/y (95% confidence interval, 0.01 to 0.20) for each 10 mL/min drop in CrCl (P=0.03).
CONCLUSIONS: these findings demonstrate that mild-to-moderate CKD is not independently associated with a reduction in peak myocardial flow or CFR and suggests that microvascular changes are unlikely to explain the high cardiovascular mortality in mild to moderate CKD. Loss of CFR, however, may accelerate in mild to moderate CKD. Further studies are needed to determine whether these changes lead to more significant reductions that may reduce peak flows and CFR and contribute to cardiovascular risk in more severe CKD.
Authors:
David M Charytan; Heinrich R Shelbert; Marcelo F Di Carli
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-09-17
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  3     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-18     Completed Date:  2010-12-23     Revised Date:  2011-09-06    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  663-71     Citation Subset:  IM    
Affiliation:
Department of Medicine, Renal Division, the Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, USA. dcharytan@partners.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Biological Markers / blood
Blood Flow Velocity
Cardiovascular Diseases / blood,  etiology*
Coronary Circulation*
Coronary Vessels / radionuclide imaging
Creatinine / blood
Exercise Test / methods
Female
Follow-Up Studies
Heart / radionuclide imaging
Humans
Kidney Failure, Chronic / complications*,  physiopathology*
Male
Microcirculation*
Middle Aged
Myocardial Perfusion Imaging / methods
Positron-Emission Tomography / methods
Risk Factors
Severity of Illness Index
Whole Body Imaging / methods
Chemical
Reg. No./Substance:
0/Biological Markers; 60-27-5/Creatinine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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