Renal resistive index and long-term outcome in patients with coronary artery disease

• Published in: BMC cardiovascular disorders Vol. 20; no. 1; pp. 322 - 9
• Main Authors: Wybraniec, Maciej T., Bożentowicz-Wikarek, Maria, Olszanecka-Glinianowicz, Magdalena, Chudek, Jerzy, Mizia-Stec, Katarzyna
• Format: Journal Article
• Language: English
• Published: London BioMed Central 06.07.2020; BioMed Central Ltd; BMC
• Subjects: Acute coronary syndromes; Aged; Angina pectoris; Angiography; Angiology; Blood flow; Blood pressure; Blood Transfusion Medicine; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Cardiovascular disease; Cerebral infarction; Clinical medicine; Coronary Angiography; Coronary artery; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary heart disease; Coronary vessels; Diagnosis; Female; Flow velocity; Heart; Heart attacks; Heart Disease Risk Factors; Heart diseases; Hemodynamics; Humans; Hypertension; Internal Medicine; Kidney; Kidney - blood supply; Kidney diseases; Kidneys; Major adverse cardiovascular events coronary artery disease; Male; Measurement; Medical examination; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Revascularization; Physiological aspects; Population; Predictive Value of Tests; Prognosis; Prospective Studies; Pulsatile Flow; Regional blood flow; Renal Artery - diagnostic imaging; Renal Artery - physiopathology; Renal Circulation; Renal pulsatility index; Renal resistive index; Research Article; Risk Assessment; Stroke - mortality; Stroke - physiopathology; Time Factors; Ultrasonic imaging; Ultrasonography, Doppler; Vascular Resistance; Ventricle; Poland; Renal pulsatility index; Major adverse cardiovascular events coronary artery disease; Renal resistive index; Coronary artery disease
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-020-01607-w

Background The study aimed to evaluate the application of intra-renal Doppler flow indices for the prediction of major adverse cardiac and cerebrovascular events (MACCE) during 24-month follow-up in patients with coronary artery disease (CAD) subject to coronary angiography (CA). Methods This prospective study comprised 111 consecutive patients with stable and unstable CAD (68.5% men; median age 65 years), referred for CA. Ultrasonographic parameters of intra-renal blood flow in arcuate/interlobular arteries, including renal resistive index (RRI) and pulsatility index (RPI), were acquired directly before and 1 h after the procedure. Endpoint of MACCE (cardiovascular death, myocardial infarction, myocardial revascularization or stroke) were recorded during 24-month follow-up. Results MACCE occurred in 14 patients (12.6%). Patients with MACCE had more diffuse CAD reflected by Syntax score (23.6 vs.14.4 pts., p  = 0.02), higher platelet level (242.4 vs. 207.2 × 1000/μl, p  = 0.01), higher rate of left main CAD (42.9% vs.5.2%, p  < 0.001) and left ventricular ejection fraction < 50% (50% vs.23.7%, p  = 0.045). Patients with MACCE had higher pre-procedural (0.68 ± 0.06 vs. 0.62 ± 0.06, p  < 0.001) and post-procedural RRI (0.72 ± 0.06 vs.0.66 ± 0.06, p  = 0.01), but comparable RPI ( p  = 0.63 and p  = 0.36, respectively). Cox proportional hazards model revealed that pre-procedural RRI (OR = 1.11 per 0.01; p  = 0.02) and left main CAD (OR = 5.75, p  = 0.002) were the only independent predictors of MACCE occurrence. Receiver operator characteristic curve analysis revealed that preprocedural RRI > 0.645 accurately predicted the composite endpoint (AUC = 0.78, p  = 0.001) and identified patients with impaired 24-month prognosis according to Kaplan-Meier curve (log-rank p  < 0.001). Conclusions Increased pre-procedural RRI, together with left main CAD, are associated with worse 24-month prognosis in patients with CAD referred for CA.