冠状动脉血管运动异常已在小型研究中进行了描述,但尚未进行系统研究。我们旨在回顾和分析目前的文献,以提高我们对慢性肾脏病(CKD)相关的冠状动脉微血管功能障碍的认识。
冠状动脉血流储备(CFR)是冠状动脉血管舒缩的众所周知的量度。我们旨在评估有和没有CKD的参与者之间CFR的差异。
PubMed,Embase,和CochraneCENTRAL进行了系统评价,以确定在有和无CKD的参与者中比较CFR的研究。我们估计了这些研究中报告的平均CFR的标准化平均差异。我们根据影像学模式进行了亚组分析,和显著的心外膜冠状动脉疾病的存在。
在14项观察性研究中,有和没有CKD的患者为5966和1410,平均估计肾小球滤过率(eGFR)为29±04和87±25ml/min/1.73m2,分别。在所有研究中,CKD患者的平均CFR始终较低,累积平均差异具有统计学意义(2.1±.3vs.2.7±0.5,标准化平均差-.8,95%CI-1.1,-.6,p<.05)。较低的平均CFR是由显著较高的平均静息流速(.58cm/s,95%CI.17,.98)和较低的平均应力流速(-.94cm/s,95%CI-1.75,-.13)在CKD研究中。即使在没有心外膜冠状动脉疾病的情况下,这种差异在诊断方式上仍然显着。在元回归中,平均eGFR和平均CFR之间存在显著正相关(p<.05)。
与没有CKD的患者相比,患有CKD的患者的CFR明显降低,即使没有心外膜冠状动脉疾病。eGFR和CFR之间存在线性关联。未来的研究需要了解这些发现的机制和治疗意义。
在这项观察性研究的荟萃分析中,有慢性肾脏病的研究与无慢性肾脏病的研究相比,冠状动脉血流储备显著减少.即使没有心外膜冠状动脉疾病,也可以看到这种差异。在元回归中,较低的估计肾小球滤过率是冠状动脉血流储备降低的重要预测指标.冠状动脉微血管功能障碍,而不是动脉粥样硬化相关的心外膜疾病可能会增加慢性肾病患者的心血管风险.
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.
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.
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.
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).
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.
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.