Vol 20, No 4 (2013)
Original articles
Published online: 2013-07-26

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Prognostic value of renal fractional flow reserve in blood pressure response after renal artery stenting (PREFER study)

Jacek Kądziela, Andrzej Januszewicz, Aleksander Prejbisz, Ilona Michałowska, Magdalena Januszewicz, Elżbieta Florczak, Łukasz Kalińczuk, Bożena Norwa-Otto, Ewa Warchoł, Adam Witkowski
DOI: 10.5603/CJ.2013.0101
Cardiol J 2013;20(4):418-422.


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.