End-stage renal failure is associated with impaired coronary microvascular function

Area of Science:

• Cardiology
• Nephrology
• Vascular Physiology

Background:

• Cardiovascular disease (CVD) is a primary cause of mortality in chronic kidney disease (CKD) patients.
• Previous research on CVD in CKD has focused on peripheral vasculature, often using noninvasive methods and excluding dialysis patients.
• This study investigates invasive coronary dynamic vascular function in end-stage renal failure (ESRF) patients.

Purpose of the Study:

• To evaluate invasive coronary dynamic vascular function in patients with end-stage renal failure (ESRF).
• To compare coronary macrovascular and microvascular function between ESRF patients and a control group.

Main Methods:

• Invasive coronary angiography was performed on patients with ESRF prior to renal transplantation and on control subjects.
• Coronary diameter and blood flow were measured using quantitative coronary angiography and Doppler Flowire.
• Macrovascular endothelial-dependent (acetylcholine) and independent (glyceryl trinitrate) functions were assessed.
• Microvascular function was evaluated by coronary flow velocity reserve in response to adenosine.

Main Results:

• The study included 15 ESRF patients and 15 controls, with similar baseline characteristics apart from ESRF.
• Endothelial-dependent and independent coronary vasoreactivity were preserved in ESRF patients compared to controls.
• A significantly reduced coronary flow velocity reserve (microvascular function) was observed in ESRF patients (2.34 ± 0.4) versus controls (3.05 ± 0.3).

Conclusions:

• Patients with ESRF exhibit preserved endothelial-dependent macrovascular function.
• ESRF is associated with significantly attenuated coronary microvascular reserve, indicated by a reduced response to adenosine.
• Impaired microvascular function in ESRF may contribute to the pathophysiology of CVD and affect the diagnostic accuracy of vasodilatory stress tests.