JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B 2016 Vol.17 No.1 P.67-75

Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease

Author(s): Hao-jian Dong, Cheng Huang, De-mou Luo, Jing-guang Ye, Jun-qing Yang, Guang Li, Jian-fang Luo, Ying-ling Zhou
Affiliation(s): Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510080, China
Corresponding email(s): donghaojian@sina.com, zylgdh@163.com
Key Words: Coronary artery disease (CAD), Heart failure with preserved ejection fraction (HFpEF), Percutaneous transluminal renal artery stenting (PTRAS), Renal artery stenosis

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Abstract: percutaneous transluminal renal artery stenting (PTRAS) has been proved to have no more benefit than medication alone in treating atherosclerotic renal artery stenosis (ARAS). Whether PTRAS could improve left ventricular hypertrophy (LVH) and reduce adverse events when based on percutaneous coronary intervention (PCI) for patients with coronary artery disease (CAD) and ARAS is still unclear. A retrospective study was conducted, which explored the effect of concomitant PCI and PTRAS versus PCI alone for patients with CAD and ARAS complicated by heart failure with preserved ejection fraction (HFpEF). A total of 228 patients meeting inclusion criteria were divided into two groups: (1) the HFpEF-I group, with PCI and PTRAS; (2) the HFpEF-II group, with PCI alone. Both groups had a two-year follow-up. The left ventricular mass index (LVMI) and other clinical characteristics were compared between groups. During the follow-up period, a substantial decrease in systolic blood pressure (SBP) was observed in the HFpEF-I group, but not in the HFpEF-II group. There was marked decrease in LVMI in both groups, but the HFpEF-I group showed a greater decrease than the HFpEF-II group. Regression analysis demonstrated that PTRAS was significantly associated with LVMI reduction and fewer adverse events after adjusting for other factors. In HFpEF patients with both CAD and ARAS, concomitant PCI and PTRAS can improve LVH and decrease the incidence of adverse events more than PCI alone. This study highlights the beneficial effect of ARAS revascularization, as a new and more aggressive revascularization strategy for such high-risk patients.

冠脉合并肾动脉狭窄同期血运重建术比单纯冠脉介入更能减轻左室肥厚

目的：研究经皮肾动脉支架术（PTRAS）能否在冠脉介入（PCI）基础上进一步改善冠心病合并肾动脉狭窄患者的左室肥厚（LVH）及减少主要心血管不良事件的发生。
创新点：本研究对集中入选全身动脉粥样硬化这类高危患者（冠心病合并肾动脉狭窄（CAD & ARAS））临床诊治进行研究，有别于既往对单纯的肾动脉狭窄（RAS）人群的研究，且入选标准使用选择性动脉造影以排除其他诊断手段可能带来的假阴性或假阳性，并对冠脉狭窄进行血运重建以解决心肌灌注问题，再对PTRAS进行评价；有别于既往对PTRAS较为保守的建议，本研究发现对于CAD & ARAS患者，肾动脉狭窄的血运重建应该更加积极，RAS的介入治疗可能是该类患者一个重要的治疗靶点。
方法：将入选的228名CAD & ARAS患者，分为收缩功能保留性心衰-I（HFpEF-I）组（PCI & PTRAS）以及HFpEF-II组（单纯PCI），术后随访至少两年。随访发现，两组的左室重量指数（LVMI）均较基线明显下降，且HFpEF-I组下降幅达大于HFpEF-II组（Δ=(32.80±12.62) g/m² vs. Δ=(18.52±8.17) g/m², P<0.001），回归分析发现PTRAS与LVMI的下降及不良事件的发生减少密切相关。
结论：对于CAD & ARAS并HFpEF患者，同期行PCI及PTRAS可较单纯PCI进一步减轻LVH及降低心血管不良事件发生。对该类高危患者，可予以积极的肾动脉狭窄血运重建治疗。

关键词：经皮肾动脉支架术；冠心病；肾动脉狭窄

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冠脉合并肾动脉狭窄同期血运重建术比单纯冠脉介入更能减轻左室肥厚

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