Related Experiment Video
Updated: Aug 14, 2025
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Prognostic Impact of Coronary Flow Reserve in Patients With CKD
Sugeon Park1, Seung Hun Lee2, Doosup Shin3
1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
Chronic kidney disease (CKD) is linked to lower coronary flow reserve (CFR), increasing the risk of cardiac events. Both CKD and reduced CFR independently predict adverse cardiac outcomes in patients with deferred revascularization.
Area of Science:
- Cardiology
- Nephrology
- Cardiovascular Physiology
Background:
- Coronary flow reserve (CFR) and chronic kidney disease (CKD) are independently associated with adverse cardiac events.
- The interrelationship between CFR and CKD in predicting cardiac outcomes remains unclear.
- Understanding this association is crucial for risk stratification in patients with coronary artery disease.
Purpose of the Study:
- To evaluate the association between intracoronary physiologic indexes, specifically CFR, and CKD.
- To determine the prognostic implications of the interplay between CFR and CKD on adverse cardiac events.
Main Methods:
- Analysis of 351 patients without left ventricular systolic dysfunction or dialysis, with deferred revascularization (FFR > 0.80).
- Coronary flow reserve (CFR) was assessed, with depressed CFR defined as CFR ≤ 2.0.
- Primary outcome: composite of cardiac death or hospitalization for heart failure at 3 years.
Main Results:
- Patients with CKD exhibited significantly lower CFR compared to the non-CKD group (2.60 ± 1.09 vs. 3.28 ± 1.77, P < 0.001).
- Lower CFR was associated with estimated glomerular filtration rate (eGFR) and increased with higher CKD stages (P = 0.011).
- The CKD and depressed CFR group had the highest risk (60.0%) of adverse cardiac events; both CKD (aHR 2.614) and depressed CFR (aHR 3.237) were independent predictors.
Conclusions:
- A significant association exists between CKD severity and CFR.
- Both CKD and depressed CFR are independently associated with an increased risk of cardiac death or heart failure hospitalization.
- These findings highlight the importance of assessing both renal function and coronary physiology for cardiac risk prediction.
Introduction:
Both coronary flow reserve (CFR) and chronic kidney disease (CKD) are known to be associated with adverse cardiac events. However, it is unclear how these prognostic factors are interrelated. This study evaluated the association between intracoronary physiologic indexes and CKD and their prognostic implications.
Methods:
A total of 351 patients without left ventricular systolic dysfunction (ejection fraction ≥ 40%) and not on dialysis whose revascularization was deferred based on fractional flow reserve (FFR) > 0.80 were analyzed. Depressed CFR was defined as CFR ≤ 2.0. The primary outcome was a composite of cardiac death or hospitalization for heart failure at 3 years.
Results:
Patients with CKD showed lower CFR than the non-CKD population (3.28 ± 1.77 vs. 2.60 ± 1.09, P < 0.001), mainly driven by increased resting coronary flow. There was no significant difference in hyperemic coronary flow, FFR, and index of microvascular resistance between the 2 groups. CFR was significantly associated with estimated glomerular filtration rate (eGFR) (P = 0.045), and the proportion of depressed CFR was significantly increased with higher CKD stages (P = 0.011). The risk of cardiac death or hospitalization for heart failure was the lowest in the non-CKD and preserved CFR group (11.9%) and the highest in the CKD and depressed CFR group (60.0%, overall log rank P < 0.001). Both CKD (adjusted hazard ratio [HRadj] 2.614, 95% confidence interval [CI] 1.505-4.539, P < 0.001) and depressed CFR (HRadj 3.237, 95% CI 2.015-5.199, P < 0.001) were independently associated with the risk of the primary outcome.
Conclusion:
There was a significant association between severity of CKD and CFR. Both CKD and depressed CFR showed independent association with higher risk of cardiac death or hospitalization for heart failure.
Related Concept Videos
01:28Chronic Kidney Disease III: Interprofessional Care
01:25Chronic Kidney Disease I: Introduction
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:24Chronic Kidney Disease II: Clinical Manifestations
01:18Chronic Kidney Disease IV: Nursing Management