Does Mild Renal Failure Affect Coronary Flow Reserve after Coronary Artery Bypass Graft Surgery?
DOI:
https://doi.org/10.1532/HSF98.2013272Abstract
Introduction: There are only a limited number of studies on the link between mild renal failure and coronary artery disease. The purpose of this study is to investigate the effects of mild renal failure on the distal vascular bed by measuring the coronary flow reserve (CFR) in transthoracic echocar-diography after coronary artery bypass grafting (CABG)
Methods: The study included 52 consecutive patients (12 women and 40 men) who had undergone uncomplicated CABG. The patients were divided into 2 groups. Group 1 included patients with a preoperative glomerular filtra-tion rate (GFR) of 60-90 (mild renal failure), and group 2 included those with a GFR >90. The CFR measurements were carried out through a second harmonic transthoracic Doppler echocardiography.
Results: The mean age was 60.08 ± 1.56 years in group 1 and 60.33 ± 1.19 in group 2. The mean preoperative CFR was 1.79 ± 0.06 in group 1 and 2.05 ± 0.09 in group 2. The mean postoperative CFR was 2.09 ± 0.08 in group 1 and 2.37 ± 0.06 in group 2. There was a statistically significant difference between the 2 groups as to preoperative creatinine clearance, preopera-tive estimated GFR, postoperative day 7 creatinine clearance, postoperative month 6 creatinine clearance, postoperative day 7 estimated GFR, postoperative month 6 estimated GFR, pre-operative CFR, and postoperative CFR (P < .05). After bypass surgery, there was a significant increase in the mean postopera-tive CFR, when compared with the mean preoperative CFR (P = .001).
Conclusion: In our study, we detected a decrease in CFR in patients with mild renal failure. We believe that in patients undergoing CABG for coronary artery disease, mild renal failure can produce adverse effects due to deterioration of the microvascular bed.
References
Anderson RJ, O'brien M, MaWhinney S, et al. 1999. Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery. VA Cooperative Study #5. Kidney Int 55:1057-62.nAnevakar NS, McMurray JJ, Velasquez EJ, et al. 2004. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 351:1285-95.nCooper WA, O'Brien SM, Thourani VH, et al. 2006. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 113:1063-70.nDimitrow PP. 2003. Transthoracic Doppler echocardiography-noninvasive diagnostic window for coronary flow reserve assessment. Cardiovasc Ultrasound 11;1:4.nEknoyan G, Hostetter T, Bakris GL, et al. 2003. Proteinuria and other markers of chronic kidney disease: a position statement of the National Kidney Foundation (NKF) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Am J Kidney Dis 42:617-22.nGould KL, Lipscomb K. 1974. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol 34:48-55.nHayashida N, Chihara S, Tayama E, et al. 2001. Coronary artery bypass grafting in patients with mild renal insufficiency. Jpn Circ J 65:28-32.nHillis GS, Croal BL, Buchan KG, et al. 2006. Renal function and outcome from coronary artery bypass grafting impact on mortality after a 2.3-year follow-up. Circulation 113:1056-62.nHirose H, Amano A, Takahashi A, Nagano N. 2001. Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine > or =2.0 mg/dL). Eur J Cardiothorac Surg 20:565-72.nHolzmann MJ, Hammar N, Ahnve S, Nordqvist T, Pehrsson K, Ivert T. 2007. Renal insufficiency and long-term mortality and incidence of myocardial infarction in patients undergoing coronary artery bypass grafting. Eur Heart J 28:865-71.nHowell NJ, Keogh BE, Bonser RS, et al. 2008. Mild renal dysfunction predicts in-hospital mortality and post-discharge survival following cardiac surgery. Eur J Cardiothorac Surg 34:390-5.nHozumi T, Yoshida K, Ogata Y, et al. 1998. Noninvasive assessment of significant left anterior descending coronary artery stenosis by coronary flow velocity reserve with transthoracic color Doppler echocardiography. Circulation 97:1557-62.nKangasniemi OP, Mahar MA, Rasinaho E, et al. 2008. Impact of estimated glomerular filtration rate on the 15-year outcome after coronary artery bypass surgery. Eur J Cardiothorac Surg 33:198-202.nKorcarz CE, Stein JH. 2004. Noninvasive assessment of coronary flow reserve by echocardiography: technical considerations. J Am Soc Echocardiogr 17:704-7.nLabrousse L, de Vincentiis C. Madonna F, Deville C, Roques X, Baudet E. 1999. Early and long-term results of coronary artery bypass grafts in patients with dialysis dependent renal failure. Eur J Cardiothorac Surg 15:691-6.nLevey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. 1999. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461-70.nLevey AS, Coresh J, Balk E, et al. 2003. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137-47.nNashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. 1999. European system for cardiac operative risk evaluation (EuroScore). Eur J Cardiothorac Surg 16:9-13.nNishida H, Uchikawa S, Chikazawa G, et al. 2001. Coronary artery bypass grafting in 105 patients with hemodialysis-dependent renal failure. Artif Organs 25:268-72.nParsonnet V, Dean D, Bernstein AD. 1989. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 79:I3-12.nPuddu PE, Mariano E, Voci P, Pizzuto F. 2012. Prediction of long-term ischemic events by noninvasively assessed coronary flow reserve. J Cardiovasc Med 13:483-90.nRigo F. 2005. Coronary flow reserve in stress-echo lab. From pathophysiologic toy to diagnostic tool. Cardiovasc Ultrasound 3:8.nSajja LR, Mannam G, Chakravarthy RM, et al. 2007. Coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non-dialysis dependent renal insufficiency: a randomized study. J Thorac Cardiovasc Surg 133:378-88.nStevens LA, Coresh J, Greene T, Levey AS. 2006. Assessing kidney function: measured and estimated glomerular filtration rate. N Engl J Med 354:2473-83.nTok D, Gullu H, Erdogan D, et al. 2005. Impaired coronary flow reserve in hemodialysis patients: a transthoracic Doppler echocardiographic study. Nephron Clin Pract 101:200-6.nTyralla K, Amann K. 2003. Morphology of the heart and arteries in renal failure. Kidney Int Suppl (84):S80-3.nZakeri R, Freemantle N, Barnett V, et al. 2005. Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation 112(9 Suppl):I270-5.n
