TY - JOUR
T1 - Coronary flow abnormalities in chronic kidney disease
T2 - A systematic review and meta-analysis
AU - Jain, Vardhmaan
AU - Gupta, Kartik
AU - Bhatia, Kirtipal
AU - Rajapreyar, Indranee
AU - Singh, Amitoj
AU - Zhou, Wunan
AU - Klein, Allan
AU - Nanda, Navin C.
AU - Prabhu, Sumanth D.
AU - Bajaj, Navkaranbir S.
N1 - Publisher Copyright:
© 2022 Wiley Periodicals LLC.
PY - 2022/11
Y1 - 2022/11
N2 - Background: Coronary vasomotion abnormalities have been described in small studies but not studied systematically. We aimed to review the present literature and analyze it to improve our understanding of chronic kidney disease (CKD) related-coronary microvascular dysfunction. Objective: Coronary flow reserve (CFR) is a well-known measure of coronary vasomotion. We aimed to assess the difference in CFR among participants with and without CKD. Methods: PubMed, Embase, and Cochrane CENTRAL were systematically reviewed to identify studies that compared CFR in participants with and without CKD. We estimated standardized mean differences in mean CFR reported in these studies. We performed subgroup analyses according to imaging modality, and the presence of significant epicardial coronary artery disease. Results: In 14 observational studies with 5966 and 1410 patients with and without CKD, the mean estimated glomerular filtration rate (eGFR) was 29 ± 04 and 87 ± 25 ml/min/1.73 m2, respectively. Mean CFR was consistently lower in patients with CKD in all studies and the cumulative mean difference was statistically significant (2.1 ±.3 vs. 2.7 ±.5, standardized mean difference −.8, 95% CI −1.1, −.6, p <.05). The lower mean CFR was driven by both significantly higher mean resting flow velocity (.58 cm/s, 95% CI.17,.98) and lower mean stress flow velocity (−.94 cm/s, 95% CI −1.75, −.13) in studies with CKD. This difference remained significant across diagnostic modalities and even in absence of epicardial coronary artery disease. In meta-regression, there was a significant positive relationship between mean eGFR and mean CFR (p <.05). Conclusion: Patients with CKD have a significantly lower CFR versus those without CKD, even in absence of epicardial coronary artery disease. There is a linear association between eGFR and CFR. Future studies are required to understand the mechanisms and therapeutic implications of these findings. Key Points: In this meta-analysis of observational studies, there was a significant reduction in coronary flow reserve in studies with chronic kidney disease versus those without. This difference was seen even in absence of epicardial coronary artery disease. In meta-regression, a lower estimate glomerular filtration rate was a significant predictor of lower coronary flow reserve. Coronary microvascular dysfunction, rather than atherosclerosis-related epicardial disease may underly increase cardiovascular risk in a patient with chronic kidney disease.
AB - Background: Coronary vasomotion abnormalities have been described in small studies but not studied systematically. We aimed to review the present literature and analyze it to improve our understanding of chronic kidney disease (CKD) related-coronary microvascular dysfunction. Objective: Coronary flow reserve (CFR) is a well-known measure of coronary vasomotion. We aimed to assess the difference in CFR among participants with and without CKD. Methods: PubMed, Embase, and Cochrane CENTRAL were systematically reviewed to identify studies that compared CFR in participants with and without CKD. We estimated standardized mean differences in mean CFR reported in these studies. We performed subgroup analyses according to imaging modality, and the presence of significant epicardial coronary artery disease. Results: In 14 observational studies with 5966 and 1410 patients with and without CKD, the mean estimated glomerular filtration rate (eGFR) was 29 ± 04 and 87 ± 25 ml/min/1.73 m2, respectively. Mean CFR was consistently lower in patients with CKD in all studies and the cumulative mean difference was statistically significant (2.1 ±.3 vs. 2.7 ±.5, standardized mean difference −.8, 95% CI −1.1, −.6, p <.05). The lower mean CFR was driven by both significantly higher mean resting flow velocity (.58 cm/s, 95% CI.17,.98) and lower mean stress flow velocity (−.94 cm/s, 95% CI −1.75, −.13) in studies with CKD. This difference remained significant across diagnostic modalities and even in absence of epicardial coronary artery disease. In meta-regression, there was a significant positive relationship between mean eGFR and mean CFR (p <.05). Conclusion: Patients with CKD have a significantly lower CFR versus those without CKD, even in absence of epicardial coronary artery disease. There is a linear association between eGFR and CFR. Future studies are required to understand the mechanisms and therapeutic implications of these findings. Key Points: In this meta-analysis of observational studies, there was a significant reduction in coronary flow reserve in studies with chronic kidney disease versus those without. This difference was seen even in absence of epicardial coronary artery disease. In meta-regression, a lower estimate glomerular filtration rate was a significant predictor of lower coronary flow reserve. Coronary microvascular dysfunction, rather than atherosclerosis-related epicardial disease may underly increase cardiovascular risk in a patient with chronic kidney disease.
KW - chronic kidney disease
KW - coronary flow reserve
KW - coronary microvascular dysfunction
UR - http://www.scopus.com/inward/record.url?scp=85139206092&partnerID=8YFLogxK
U2 - 10.1111/echo.15445
DO - 10.1111/echo.15445
M3 - Article
C2 - 36198077
AN - SCOPUS:85139206092
SN - 0742-2822
VL - 39
SP - 1382
EP - 1390
JO - Echocardiography
JF - Echocardiography
IS - 11
ER -