Vol 20, No 4 (2013)
Original articles
Published online: 2013-07-26
Prognostic value of renal fractional flow reserve in blood pressure response after renal artery stenting (PREFER study)
DOI: 10.5603/CJ.2013.0101
Cardiol J 2013;20(4):418-422.
Abstract
Background: The aim of our study was to determine a potential relationship between resting
translesional pressures ratio (Pd/Pa ratio), renal fractional fl ow reserve (rFFR) and blood
pressure response after renal artery stenting.
Methods: Thirty fi ve hypertensive patients (49% males, mean age 64 years) with at least
60% stenosis in angiography, underwent renal artery stenting. Translesional systolic pressure
gradient (TSPG), Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures)
and hyperemic rFFR — after intrarenal administration of papaverine — were measured before
stent implantation. Ambulatory blood pressure measurements (ABPM) were recorded before
the procedure and after 6 months. The ABPM results were presented as blood pressure changes
in subgroups of patients with normal (≥ 0.9) vs. abnormal (< 0.9) Pd/Pa ratio and normal
(≥ 0.8) vs. abnormal (< 0.8) rFFR.
Results: Median Pd/Pa ratio was 0.84 (interquartile range 0.79–0.91) and strongly correlated
with TSPG (r = –0.89, p < 0.001), minimal lumen diameter (MLD; r = 0.53, p < 0.005)
and diameter stenosis (DS; r = –0.51, p < 0.005). Median rFFR was 0.78 (0.72–0.82). Similarly,
signifi cant correlation between rFFR and TSPG (r = –0.86, p < 0.0001), as well as with
MLD (r = 0.50, p < 0.005) and DS (r = –0.51, p < 0.005) was observed. Procedural success
was obtained in all patients. Baseline Pd/Pa ratio and rFFR did not predict hypertension response
after renal artery stenting. Median changes of 24-h systolic/diastolic blood pressure were
comparable in patients with abnormal vs. normal Pd/Pa ratio (–4/–3 vs. 0/2 mm Hg; p = NS)
and with abnormal vs. normal rFFR (–2/–1 vs. –2/–0.5 mm Hg, respectively).
Conclusions: Physiological assessment of renal artery stenosis using Pd/Pa ratio and papaverine-
induced renal fractional fl ow reserve did not predict hypertension response after renal
artery stenting.
translesional pressures ratio (Pd/Pa ratio), renal fractional fl ow reserve (rFFR) and blood
pressure response after renal artery stenting.
Methods: Thirty fi ve hypertensive patients (49% males, mean age 64 years) with at least
60% stenosis in angiography, underwent renal artery stenting. Translesional systolic pressure
gradient (TSPG), Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures)
and hyperemic rFFR — after intrarenal administration of papaverine — were measured before
stent implantation. Ambulatory blood pressure measurements (ABPM) were recorded before
the procedure and after 6 months. The ABPM results were presented as blood pressure changes
in subgroups of patients with normal (≥ 0.9) vs. abnormal (< 0.9) Pd/Pa ratio and normal
(≥ 0.8) vs. abnormal (< 0.8) rFFR.
Results: Median Pd/Pa ratio was 0.84 (interquartile range 0.79–0.91) and strongly correlated
with TSPG (r = –0.89, p < 0.001), minimal lumen diameter (MLD; r = 0.53, p < 0.005)
and diameter stenosis (DS; r = –0.51, p < 0.005). Median rFFR was 0.78 (0.72–0.82). Similarly,
signifi cant correlation between rFFR and TSPG (r = –0.86, p < 0.0001), as well as with
MLD (r = 0.50, p < 0.005) and DS (r = –0.51, p < 0.005) was observed. Procedural success
was obtained in all patients. Baseline Pd/Pa ratio and rFFR did not predict hypertension response
after renal artery stenting. Median changes of 24-h systolic/diastolic blood pressure were
comparable in patients with abnormal vs. normal Pd/Pa ratio (–4/–3 vs. 0/2 mm Hg; p = NS)
and with abnormal vs. normal rFFR (–2/–1 vs. –2/–0.5 mm Hg, respectively).
Conclusions: Physiological assessment of renal artery stenosis using Pd/Pa ratio and papaverine-
induced renal fractional fl ow reserve did not predict hypertension response after renal
artery stenting.
Keywords: fractional fl ow reserverenal artery stentingpressures ratio
