Related Experiment Video
Updated: May 17, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Coronary vascular dysfunction and prognosis in patients with chronic kidney disease
Venkatesh L Murthy1, Masanao Naya, Courtney R Foster
1Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA 02115, USA.
Insights
Impaired coronary vasodilator function, identified by positron emission tomography, significantly increases cardiac death risk in patients with renal dysfunction. This finding improves cardiac risk assessment beyond traditional markers.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Renal Dysfunction and Cardiac Complications
- Coronary Artery Disease Pathophysiology
Background:
- Patients with renal dysfunction face elevated risks of adverse cardiac events, independent of overt ischemia.
- Impaired vasodilator function is an early indicator of coronary artery disease, preceding detectable stenosis.
Purpose of the Study:
- To determine if impaired vasodilator function contributes to increased cardiac risk in patients with moderate to severe renal dysfunction.
- To assess the role of coronary flow reserve (CFR) as a predictor of cardiac mortality in this patient population.
Main Methods:
- 866 patients with moderate to severe renal dysfunction underwent rest/stress myocardial perfusion positron emission tomography (PET).
- Coronary flow reserve (CFR) was calculated from PET-derived myocardial blood flow.
- Patients were followed for a median of 1.28 years, with cardiac death as the primary endpoint.
Main Results:
- A 3-year cardiac mortality rate of 16.2% was observed.
- Low coronary flow reserve (CFR < 1.5) independently predicted a 2.1-fold increase in cardiac death risk (p = 0.004).
- Incorporating CFR significantly improved risk prediction models, particularly for intermediate-risk patients (net reclassification improvement 0.489).
Conclusions:
- Coronary vascular dysfunction, assessed by PET-derived CFR, is a potent, independent predictor of cardiac mortality in patients with renal dysfunction.
- CFR provides significant incremental risk stratification beyond conventional clinical markers.
Objectives:
This study sought to evaluate whether impaired vasodilator function, an early manifestation of coronary artery disease, which precedes angiographic stenosis, accounts for increased risk among patients with moderate to severe renal dysfunction.
Background:
Patients with renal dysfunction are at increased risk of adverse cardiac outcomes, even in the absence of overt myocardial ischemia or infarction.
Methods:
We included 866 consecutive patients with moderate to severe renal dysfunction referred for rest and stress myocardial perfusion positron emission tomography and followed them for a median of 1.28 years (interquartile range: 0.64 to 2.34). Regional myocardial perfusion abnormalities were assessed by semiquantitative visual analysis of positron emission tomography images. Rest and stress myocardial blood flow were calculated using factor analysis and a 2-compartment kinetic model; they were also used to compute coronary flow reserve (stress/rest myocardial blood flow). The primary endpoint was cardiac death.
Results:
Overall, 3-year cardiac mortality was 16.2%. After adjusting for clinical risk, left ventricular ejection fraction, as well as the magnitude of scar and/or ischemia, coronary flow reserve below the median (<1.5) was associated with a 2.1-fold increase in the risk of cardiac death (95% confidence interval [CI]: 1.3 to 3.5, p = 0.004). Incorporation of coronary flow reserve into cardiac death risk assessment models resulted in an increase in the C-index from 0.75 to 0.77 (p = 0.05) and in a net reclassification improvement of 0.142 (95% CI: 0.076 to 0.219). Among patients at intermediate risk based on all data other than coronary flow reserve, the net reclassification improvement was 0.489 (95% CI: 0.192 to 0.836). Corresponding improvements in risk assessment for mortality from any cause were also demonstrated.
Conclusions:
The presence of coronary vascular dysfunction in patients with moderate to severe renal dysfunction, as assessed by positron emission tomography, is a powerful, independent predictor of cardiac mortality and provides meaningful incremental risk stratification over conventional markers of clinical risk.
Related Concept Videos
01:25Chronic Kidney Disease I: Introduction
01:28Chronic Kidney Disease III: Interprofessional Care
01:24Chronic Kidney Disease II: Clinical Manifestations
01:18Chronic Kidney Disease IV: Nursing Management
01:28Diabetic Nephropathy
01:29Acute Kidney Injury II: Pathophysiology