Coronary microvascular dysfunction was found to be associated with an increased risk for cardiovascular events and cardiac dysfunction in patients with chronic kidney disease, according to a study published in Circulation.

In this longitudinal study, 352 patients without overt coronary, valvular, or end-organ disease, who underwent cardiac stress positron emission tomography (PET), echocardiogram, and renal function assessment at Brigham and Women’s Hospital in Boston, Massachusetts, between 2006 and 2016 were enrolled. Patients were followed up, and a composite of adverse outcomes (ie, death, hospitalization for myocardial infarction, or heart failure) was recorded.

Echocardiograms were used to measure cardiac mechanics, including diastolic and systolic (including circumferential strain) function, and PET was used to determine coronary flow reserve (CFR).

In this cohort, 70% of patients had abnormally left ventricular remodeling, and most patients had a clinical history of either hypertension, dyslipidemia, or diabetes mellitus. A total of 108 patients met the primary composite endpoint of major adverse cardiac events (MACE) over a median follow-up period of 4.4 years.

Individuals with stage ≥3 chronic kidney disease had higher N-terminal pro–B-type natriuretic peptide compared with patients with preserved estimated glomerular filtration rate (eGFR; P <.001). In multivariable models that included CFR and eGFR, CFR, but not eGFR, was found to be associated with an increased risk for MACE (P =.015). Abnormal CFR remained associated with an increased risk for MACE in an analysis in which the distinction was made between abnormal and severely abnormal CFR (adjusted hazard ratio, 1.61; 95% CI, 1.05-2.46; P =.029). Lower eGFR and CFR were associated with worse systolic strain (P <.05).

Study limitations include its single-center design as well as the sole inclusion of symptomatic patients referred for suspected ischemic heart disease.

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“[O]ur study raises the possibility that efforts to attenuate microvascular disease could produce benefits on myocardial dysfunction and cardiovascular disease events,” concluded the study authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Bajaj NS, Singh A, Zhou W, et al. Coronary microvascular dysfunction, left ventricular remodeling, and clinical outcomes in patients with chronic kidney impairment. Circulation. 2020;141(1):21-33.