Estimation of the Prevalence of Microcirculatory Dysfunction in Uremic Cardiopathy Among Dialysis Patients

Estimation of the Prevalence of Microcirculatory Dysfunction in Uremic Cardiopathy Among Dialysis Patients

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.

Inclusion Criteria:

• 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
• Patients registered with the National Health Service or eligible for it

Exclusion Criteria:

• Age > 90 years
• Patient undergoing daily home haemodialysis
• Symptomatic stage 3 or 4 peripheral arterial disease
• Severe hypertrophic cardiomyopathy (genetic or amyloid)
• Severe valvular heart disease leading to left ventricular remodelling (surgically contraindicated severe aortic stenosis, severe mitral regurgitation, severe aortic regurgitation)
• Hospitalisation for decompensation/acute heart failure within the last month
• Acute coronary syndrome and any coronary artery disease requiring angioplasty and/or stent implantation within the last 3 months
• Contraindication to METHERGIN and DOBUTAMINE
• Patients participating in another clinical research protocol that may affect the research objectives
• Patients already included in the study
• Patients under guardianship, curatorship or deprived of their liberty
• Patients under an activated future protection order
• Patients under family authorisation
• Patient under judicial protection
• Pregnant patient