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Multicenter Study
. 2015 May 7;10(5):e0125374.
doi: 10.1371/journal.pone.0125374. eCollection 2015.

Renal function and coronary microvascular dysfunction in women with symptoms/signs of ischemia

Rajesh Mohandas  1 , Mark S Segal  1 , Tianyao Huo  2 , Eileen M Handberg  2 , John W Petersen  2 , B Delia Johnson  3 , George Sopko  4 , C Noel Bairey Merz  5 , Carl J Pepine  2
Affiliations
Multicenter Study

Renal function and coronary microvascular dysfunction in women with symptoms/signs of ischemia

Rajesh Mohandas et al. PLoS One. .

Abstract

Objectives: Chronic kidney disease (CKD) is more prevalent among women and is associated with adverse cardiovascular events. Among women with symptoms and signs of ischemia enrolled in the Women's Ischemia Syndrome Evaluation (WISE), a relatively high mortality rate was observed in those with no obstructive coronary artery disease. Coronary microvascular dysfunction or reduced coronary flow reserve (CFR) was a strong and independent predictor of adverse outcomes. The objective of this analysis was to determine if renal function was associated with coronary microvascular dysfunction in women with signs and symptoms of ischemia.

Methods: The WISE was a multicenter, prospective, cohort study of women undergoing coronary angiography for suspected ischemia. Among 198 women with additional measurements of CFR, we determined the estimated glomerular filtration rate (eGFR) with the CKD-EPI equation. We tested the association between eGFR and CFR with regression analysis.

Results: The median eGFR was 89 ml/min. The eGFR correlated with CFR (r = 0.22; P = 0.002). This association persisted even after covariate adjustment. Each 10-unit decrease in eGFR was associated with a 0.04-unit decrease in CFR (P = 0.04).There was a strong interaction between eGFR and age (P = 0.006): in those ≥60 years old, GFR was strongly correlated with CFR (r = 0.55; P<0.0001). No significant correlation was noted in those <60 years old.

Conclusions: Reduced renal function was significantly associated with lower CFR in women with symptoms and signs of ischemia. Coronary microvascular dysfunction warrants additional study as a mechanism contributing to increased risk of cardiovascular events in CKD.

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Conflict of interest statement

Competing Interests: QMED, Inc., partly funded this study. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Linear Regression of CFR and eGFR.
Coronary flow reserve (CFR) was log transformed. Estimated glomerular filtration rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
Fig 2
Fig 2. Scatter plot of eGFR and Log2CFR in women (A) <60 years of age (n = 135) and (B) ≥60 years of age (n = 63).
C oronary flow reserve (CFR) was log transformed. Estimated glomerular filtration rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
See this image and copyright information in PMC

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