Importance of measuring the fractional flow reserve in patients receiving hemodialysis

  • Akiko Matsuo
  • Hiroshi Fujita
  • Akira Ueoka
  • Naoki Maruyama
  • Yoshiaki Shimoda
  • Eigo Kishita
  • Yoshinori Tsubakimoto
  • Tomohiko Sakatani
  • Keiji Inoue
  • Makoto Kitamura
  • Masato Nishimura
Original Article

Abstract

Angiography is not always an accurate indicator of physiologically significant stenosis. We examined the usefulness of functional evaluation of coronary stenosis severity by determining the fractional flow reserve (FFR) using a pressure wire in patients who received hemodialysis with angiographically intermediate lesions. We recruited 44 patients with intermediate lesions; of these, 22 were undergoing hemodialysis while 22 were not. Quantitative coronary angiography (QCA) was performed to measure the minimal lumen diameter (MLD) and calculate the percent diameter stenosis (%DS). The FFR was calculated as the ratio of the coronary pressure at the distal stenotic site to the mean aortic pressure during maximum hyperemia. In each group, we investigated the relationship between the FFR and %DS and FFR and MLD. The patients in the hemodialysis group were significantly younger and had more calcified and type B2/C lesions than those in the non-dialysis group. Although the FFR was correlated with both %DS (r = 0.71, p < 0.01) and MLD (r = 0.58, p < 0.01) in the non-dialysis group, the FFR was not correlated with either MLD or %DS in the hemodialysis group. In the hemodialysis group, there was a discordance between the QCA- and FFR-based assessments of the severity of coronary stenosis. In patients receiving hemodialysis, both anatomical and functional assessments should be conducted to determine the physiological significance of the stenosis accurately.

Keywords

Coronary artery disease Diagnostic techniques Ischemia 

References

  1. 1.
    Pijls NHJ, De Bruyne B, Peel K, der Voort PV, Bonnir HJRM, Bartunek B, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenosis. N Engl J Med. 1996;334:1703–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Takagi A, Tsurumi Y, Ishii Y, Suzuki K, Kawana M, Kasanuki H. Clinical potential of intravascular ultrasound for physiological assessment of coronary stenosis: relationship between quantitative ultrasound tomography and pressure-derived fractional flow reserve. Circulation. 1999;100:250–5.PubMedGoogle Scholar
  3. 3.
    Jasti V, Ivan E, Yalamanchili V, Wongpraparut N, Leesar MA. Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis. Circulation. 2004;110:2831–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Kern MJ, Lerman A, Bech J-W, Bruyne BD, Eeckhout E, Fearon WF, Meuwissen M, Piek JJ, Pijls NHJ, Siebes M, Spaan JAE, et al. Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology. Circulation. 2006;114:1321–41.PubMedCrossRefGoogle Scholar
  5. 5.
    Maryland B. US renal data system 2003 annual data report: National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2003.Google Scholar
  6. 6.
    Banerjee D, Ma JZ, Collins AJ, Collins AJ, Herzog CA. Long-term survival of incident hemodialysis patients who are hospitalized for congestive heart failure, pulmonary edema, or fluid overload. Clin J Am Soc Nephrol. 2007;2:1186–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Yasuda K, Kasuga H, Aoyama T, Takahashi H, Toriyama T, Kawade Y, et al. Comparison of percutaneous coronary intervention with medication in the treatment of coronary artery disease in hemodialysis patients. J Am Soc Nephrol. 2003;17:2322–32.CrossRefGoogle Scholar
  8. 8.
    Reddan DN, Szczech LA, Tuttle RH, Shaw LK, Jones RH, Schwab SJ, et al. Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol. 2003;14:2373–80.PubMedCrossRefGoogle Scholar
  9. 9.
    Herzog CA, Ma JZ, Collins AJ. Comparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting and coronary artery bypass surgery and impact of diabetes. Circulation. 2002;106:2207–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Salah-Eddine H, William WC, Wolfram RM, Kuchulakanti PK, Xue Z, Natalie G, et al. Clinical outcomes after percutaneous coronary intervention with drug-eluting stents in dialysis patients. J invasive cardiol. 2006;18:273–7.Google Scholar
  11. 11.
    Wilson RF, White CW. Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans. Circulation. 1986;73:444–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Courtis J, Rodes-Cabau J, Larose E, Dery JP, Nguyen CM, Proulx G, et al. Comparison of medical treatment and coronary revascularization in patients with moderate coronary lesions and borderline fractional flow reserve measurements. Catheter Cardiovasc Interv. 2008;71:541–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Tonino PAL, De Bruyne B, Pijls NHJ, Siebert U, Ikeno F, Van’t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24.PubMedCrossRefGoogle Scholar
  14. 14.
    White CW, Wright CB, Doty DB, Hiratzav LF, Eastham CL, Harrison DG, Marcus ML. Does visual interpretation of the coronary arteriogram predict the physiological importance of a coronary stenosis? N Engl J Med. 1984;310:819–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Vogel RA. Assessing stenosis significance by coronary angiography: are the best variables good enough? J Am Coll Cardiol. 1988;12:692–3.PubMedGoogle Scholar
  16. 16.
    De Bruyne B, Hersbach F, Pijls NHJ, Bartunek J, Bech JW, Heyndrickx GR, et al. Abnormal epicardial coronary resistance in patients with diffuse atherosclerosis but “Normal” coronary angiography. Circulation. 2001;104:2401–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Hirota M, Iwasaki K, Yamamoto K, Kusachi S, Hina K, Hirohata S, et al. Coronary pressure measurement to identify the lesion requiring percutaneous coronary intervention in equivocal tandem lesions. Coron Artery Dis. 2006;7:181–6.CrossRefGoogle Scholar
  18. 18.
    Schwarz U, Buzello M, Ritz E, Stein G, Raabe G, Wiest G, et al. Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure. Nephrol Dial Transplant. 2000;15:218–23.PubMedCrossRefGoogle Scholar
  19. 19.
    Charytan DM, Kuntz RE. Risks of coronary artery bypass surgery in dialysis-dependent patients-analysis of the 2001 National Inpatient Sample. Nephrol Dial Transplant. 2007;22:1665–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Longenecker JC, Coresh J, Powe NR, Levey AS, Fink NE, Martin A, et al. Traditional cardiovascular disease risk factors in dialysis patients compared with the general population: the CHOICE Study. J Am Soc Nephrol. 2002;13:1918–27.PubMedCrossRefGoogle Scholar
  21. 21.
    Nishimura M, Tsukamoto K, Hasebe N, Tamaki N, Kikuchi K, Ono T. Prediction of cardiac death in hemodialysis patients by myocardial fatty acid imaging. J Am Coll Cardiol. 2008;51:139–45.PubMedCrossRefGoogle Scholar
  22. 22.
    Kunz K, Dimitrov Y, Muller S, Chanre F, Hannedouche T. Ureamic cardiomyopathy. Nephrol Dial Transplant. 1998;13:39–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Claeys MJ, Bosmans JM, Hendrix J, Vrints CJ. Reliability of fractional flow reserve measurements in patients with associated microvascular dysfunction: Importance of flow on translesional pressure gradient. Catheter Cardiovasc Interv. 2001;54:427–34.PubMedCrossRefGoogle Scholar
  24. 24.
    Meuwissen M, Chamuleau SAJ, Siebes M, Schotborgh CE, Koch KT, de Winter RJ, et al. Role of variability in microvascular resistance on fractional flow reserve and coronary blood flow velocity reserve in intermediate coronary lesions. Circulation. 2001;103:184–7.PubMedGoogle Scholar
  25. 25.
    Bech GJW, De Bruyne B, Bonnier HJRM, Bartunek J, Wijns W, Peels K, et al. Long-term follow-up after deferral of percutaneous transluminal coronary angioplasty of intermediate stenosis on the basis of coronary pressure measurement. J Am Coll Cardiol. 1998;31:841–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Pijils NHJ, Van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van’t Veer M, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis. J Am Coll Cardiol. 2007;49:2105–11.CrossRefGoogle Scholar
  27. 27.
    Sasao H, Hotta D, Maeda T, Saito N, Takagi S, Shimamoto K. Comparison of long-term clinical outcome after sirolimus-eluting stent implantation in patients with and without hemodialysis. Int Heart J. 2007;48:689–700.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2011

Authors and Affiliations

  • Akiko Matsuo
    • 1
  • Hiroshi Fujita
    • 1
  • Akira Ueoka
    • 1
  • Naoki Maruyama
    • 1
  • Yoshiaki Shimoda
    • 1
  • Eigo Kishita
    • 1
  • Yoshinori Tsubakimoto
    • 1
  • Tomohiko Sakatani
    • 1
  • Keiji Inoue
    • 1
  • Makoto Kitamura
    • 1
  • Masato Nishimura
    • 2
  1. 1.Department of CardiologyKyoto Second Red Cross HospitalKyotoJapan
  2. 2.Department of CardiologyToujinkai HospitalKyotoJapan

Personalised recommendations