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THE DIAGNOSTIC VALUE OF DELTA RI IN THE ASSESSMENT OF SEVERITY OF RENAL ARTERY STENOSIS - CORRELATION WITH ANGIOGRAPHY DATA: PP.30.200

Objective: The aim of the study was to evaluate the diagnostic value of deltaRI (side-to-side difference of renal resistive index) in moderate to high grade renal artery stenosis (RAS) with respect to angiographic and hemodynamic measurements. Design and Method: 43 hypertensive patients with at least moderate (more than 50%) RAS were investigated. GFR was calculated according to MDRD formula. Renal resistive index (RI) and deltaRI were obtained in Doppler sonography. Using the pressure wire, resting Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic renal fractional flow reserve (rFFR) after administration of 30 mg intrarenal papaverine were evaluated. The quantitative angiographic analysis (QAA) of stenosis severity was performed including the minimal lumen diameter (MLD) and the percent diameter stenosis (DS) assessment. The predictive value of different variables was calculated using Receiver-operating characteristics curves. Results: Mean deltaRI was 0,049+/−0,087. DeltaRI correlated with MLD (r = 0,39; p < 0,05), DS (r = 0,36; p < 0,01) and fFFR (r = −0,36; p < 0,05). No significant relationship between Pd/Pa ratio and deltaRI was observed. There were no correlations between deltaRI and diastolic pressure measured proximally and distally to the stenosis and GFR. Patients with rFFR < 0.8 had an increased deltaRI (0,08 vs 0,01, p < 0,1) in comparison to the patients with normal rFFR. In the ROC analysis for prediction of decrised rFFR (<0,8) area under the curve for deltaRI was 0,743 (p < 0,01). The sensitivity and specifity of deltaRI cut-off values were: for 0,025 - 75% and 60%; for 0,06 - 50% and 70%; for 0,075 - 50% and 85%; for 0,085 - 45% and 90%. Conclusions: Our data indicate the deltaRI may be a helpful marker of a significant renal artery stenosis.