Patients with end-stage renal disease have a high burden of cardiovascular mortality, yet ischemic heart disease is often asymptomatic and difficult to diagnose in this population. Recent data suggest that microvascular coronary dysfunction may contribute significantly to myocardial ischemia in dialysis patients, but its true prevalence remains unknown. This study aims to evaluate microcirculatory coronary impairment in hemodialysis patients using invasive coronary angiography with measurement of coronary flow reserve (CFR), index of microcirculatory resistance (IMR). The study will also describe the clinical and biological characteristics associated with microvascular dysfunction in this population, in order to better understand the mechanisms of uremic cardiomyopathy and improve cardiovascular risk stratification.
Age ≥ 18 years
Patients who have been on haemodialysis for at least 6 months
Elevated troponin levels > 40 ng/L in a sample taken whilst the patient was in a stable condition, dated within the last 3 months
Patients capable of understanding the protocol and who have given their written informed consent to participate in the research
Age > 90 years
Patient undergoing daily home haemodialysis
Symptomatic stage 3 or 4 peripheral arterial disease
Severe hypertrophic cardiomyopathy (genetic or amyloid)
Single group
Transthoracic ultrasound at rest
Diagnostic testTransthoracic ultrasound at rest
Cardiological stress test
Diagnostic testLeft to the discretion of the centre: dobutamine echocardiography or myocardial scintigraphy.
Coronary angiography
Diagnostic testEven even if the stress test comes back normal (these tests appear to be less effective at diagnosing microcirculatory abnormalities)
Percentage of patients with microcirculatory heart disease (i.e. microvascular dysfunction or microvascular vasospasm) identified during coronary angiography
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