Hemodyalysis
Conditions
Keywords
microcirculatory disorders, hemodyalysis
Brief summary
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.
Interventions
DIAGNOSTIC_TESTTransthoracic ultrasound at rest
Transthoracic ultrasound at rest
DIAGNOSTIC_TESTCardiological stress test
Left to the discretion of the centre: dobutamine echocardiography or myocardial scintigraphy.
DIAGNOSTIC_TESTCoronary angiography
Even even if the stress test comes back normal (these tests appear to be less effective at diagnosing microcirculatory abnormalities)
Sponsors
Centre Hospitalier Departemental Vendee
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SCREENING
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percentage of patients with microcirculatory heart disease (i.e. microvascular dysfunction or microvascular vasospasm) identified during coronary angiography | Cardiac examinations to be carried out within 8 to 10 weeks of enrolment |
Countries
France
Contacts
CONTACTChloé MOREAU
PRINCIPAL_INVESTIGATORGrégoire COUVRAT-DESVERGNES
Centre Hospitalier Departemental Vendee
Outcome results
None listed