Reviews in Cardiovascular Medicine (Oct 2024)
Impact of Kidney Function on Physiological Assessment of Coronary Circulation
Abstract
Background: Diagnosing myocardial ischemia in chronic kidney disease (CKD) patients is crucial since coronary artery disease (CAD) forms the predominant cause of mortality in these patients. Thus, this study aimed to assess the impact of kidney function on the results of coronary circulation physiological assessment. Methods: Data were collected from 279 consecutive patients admitted to the Clinical Department of Cardiology and Cardiovascular Interventions at the University Hospital in Krakow. A total of 417 vessels were assessed for fractional flow reserve (FFR) and non-hyperemic resting pressure ratios, such as instantaneous wave-free ratio (iFR) and resting full-cycle ratio (RFR). Patients were categorized into two groups: glomerular filtration rate (GFR)-L (estimated GFR (eGFR) <70 mL/min/1.73 m2) and GFR-H (eGFR ≥70 mL/min/1.73 m2). Results: A total of 118 patients (42.3%) were included in the GFR-L group, while 161 patients (57.7%) were in the GFR-H group. The left anterior descending branch of the left coronary artery (LAD) was the assessed vessel in approximately 60% of procedures, the frequency of which was very similar in both study groups. Focusing solely on LAD assessments, both FFR metrics (continuous and binary) were comparable between the groups. In contrast, for non-LAD vessels, the GFR-H group revealed substantially reduced FFR values, with more vessels displaying significant constriction. Patients in the GFR-H group showed higher instances of FFR+ $\vert{}$ iFR/RFR- discrepancies than their lower eGFR counterparts. An eGFR of 70 mL/min/1.73 m2 was the optimal cut-off to differentiate patients concerning the mentioned discrepancies. Conclusions: Kidney function influenced the coronary circulation physiological assessment results. Patients with reduced eGFR tended to have negative hyperemic assessments, especially in non-LAD vessels.
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