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Yang X, Zhang F, Zhan Y, Liu Z, Wang W, Shi J. Association between estimated plasma volume status and acute kidney injury in patients who underwent coronary revascularization: A retrospective cohort study from the MIMIC-IV database. PLoS One 2024; 19:e0300656. [PMID: 38865385 PMCID: PMC11168641 DOI: 10.1371/journal.pone.0300656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) remains a common complication of coronary revascularization and increases poor outcomes in critically ill surgical patients. Compared to the plasma volume status (PVS), estimated plasma volume status (ePVS) has the advantages of being noninvasive and simple and has been shown to be associated with worse prognosis in patients undergoing coronary revascularization. This study was to evaluate the association of ePVS with the risk of AKI in patients who underwent coronary revascularization. METHODS In this retrospective cohort study, data of patients who underwent coronary revascularization were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database (2008-2019). The outcome was the occurrence of AKI after ICU admission. The covariates were screened via the LASSO regression method. Univariate and multivariate Logistic regression models were performed to assess the association of ePVS and PVS and the odds of AKI in patients who underwent coronary revascularization, with results shown as odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses of age, surgery, and anticoagulation agents and sequential organ failure assessment (SOFA) score were performed to further explore the association of ePVS with AKI. RESULTS A total of 3,961 patients who underwent coronary revascularization were included in this study, of whom 2,863 (72.28%) had AKI. The high ePVS was associated with the higher odds of AKI in patients who received coronary revascularization (OR = 1.06, 95%CI: 1.02-1.10), after adjusting for the covariates such as age, race, SAPS-II score, SOFA score, CCI, weight, heart rate, WBC, RDW-CV, PT, BUN, glucose, calcium, PH, PaO2, mechanical ventilation, vasopressors, and diuretic. Similar results were found in patients who underwent the CABG (OR = 1.07, 95%CI: 1.02-1.11), without anticoagulation agents use (OR = 1.07, 95%CI: 1.03-1.12) and with high SOFA score (OR = 1.10, 95%CI: 1.04-1.17). No relationship was found between PVS and the odds of AKI in patients who underwent the coronary revascularization. CONCLUSION The ePVS may be a promising parameter to evaluate the risk of AKI in patients undergoing coronary revascularization, which provides a certain reference for the risk stratification management of ICU patients who underwent coronary revascularization.
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Affiliation(s)
- Xinping Yang
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Fan Zhang
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yongqiang Zhan
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhiheng Liu
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Wenjing Wang
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jiahua Shi
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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Yoshiura T, Masuda T, Kobayashi Y, Kikuhara Y, Ishibashi T, Nonaka H, Oku T, Sato T, Funama Y. Iodine contrast volume reduction in preoperative transcatheter aortic valve implantation computed tomography: Comparison with 64- and 256-multidetector row computed tomography. Radiography (Lond) 2024; 30:408-415. [PMID: 38176131 DOI: 10.1016/j.radi.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/24/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION This study aimed to compare the vascular enhancement and radiation dose in preoperative transcatheter aortic valve implantation (TAVI) computed tomography (CT) with a reduced contrast medium (CM) using volume scans in 256-multidetector row CT (MDCT) with a standard CM using 64-MDCT. METHODS This study included 78 patients with preoperative TAVI CT with either 64- or 256-MDCT. The CM was injected at 1.5 mL/kg in the 64-MDCT group and 1.0 mL/kg in the 256-MDCT group. We compared vascular enhancement of the aortic root and access routes, image quality (IQ) scores, and radiation dose in both groups. RESULTS Despite the reduced CM (by 33 %) in the 256-MDCT group, the mean vascular enhancement of the right and left subclavian arteries was significantly higher than that in the 64-MDCT group [284 and 267 Hounsfield units (HU) vs. 376 and 359 HU; p < 0.05]; however, no significant differences in the mean vascular enhancement in the ascending aorta, abdominal aorta at the celiac level, and bilateral common femoral arteries were observed between the two groups (p > 0.05 for all). The median IQ scores at the aortic root were higher in the 256-MDCT group than in the 64-MDCT group (3 vs. 4; p < 0.05), and those at the femoral access routes were comparable (4 vs. 4; p = 0.33). The mean effective dose was significantly reduced by 30 % in the 256-MDCT group (23.6 vs. 16.3 mSv; p < 0.05). CONCLUSION In preoperative TAVI CT, volume scans using 256-MDCT provide comparable or better vascular enhancement and IQ with a 30 % reduction in CM and radiation dose than those using 64-MDCT. IMPLICATIONS FOR PRACTICE Volume scan using 256-MDCT for preoperative TAVI CT may reduce CM and radiation dose in TAVI patients with renal dysfunction.
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Affiliation(s)
- T Yoshiura
- Graduate School of Health Sciences, Kumamoto University, Kuhonji 4-24-1, Chuo-ku, Kumamoto, 860-0976, Japan; Department of Medical Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan.
| | - T Masuda
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Matsushima 288, Okayama, 701-0193, Japan.
| | - Y Kobayashi
- Department of Medical Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan.
| | - Y Kikuhara
- Department of Medical Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan.
| | - T Ishibashi
- Department of Medical Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan.
| | - H Nonaka
- Department of Medical Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan.
| | - T Oku
- Department of Medical Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan.
| | - T Sato
- Department of Medical Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan.
| | - Y Funama
- Department of Medical Radiation Sciences, Faculty of Life Sciences, Kumamoto University, Honjo 1-1-1, Chuo-ku, Kumamoto, 860-8556, Japan.
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Shuka N, Hasimi E, Kristo A, Simoni L, Gishto T, Shirka E, Zaimi Petrela E, Goda A. Contrast-Induced Nephropathy in Interventional Cardiology: Incidence, Risk Factors, and Identification of High-Risk Patients. Cureus 2023; 15:e51283. [PMID: 38288173 PMCID: PMC10823194 DOI: 10.7759/cureus.51283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
AIM This study aimed to study contrast-induced nephropathy (CIN) or more recent nomenclature contrast-associated acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary procedures, evaluating CIN incidence, risk factors (RFs), and high-risk patients with CIN. Methods: This is a prospective, observational, unicentric trial of patients who underwent coronary angiography and/or percutaneous coronary intervention (PCI) in the University Hospital Center (UHC) "Mother Teresa" in Tirana, Albania, during 2016-2018. CIN was defined as an increase of 25% and/or by 0.5 mg/dL of serum creatinine (SCr) and high-risk patients with CIN as an increase by 50% and/or by 2 mg/dL and/or need for dialysis compared to the basal pre-procedural values. We evaluated RFs for CIN: preexisting renal lesion (PRL), heart failure (HF), age, diabetes mellitus (DM), anemia, and contrast quantity. Results: The incidence of CIN resulted in 14.4%. HF, PRL, and age ≥65 years resulted in independent RFs for CIN, whereas anemia, DM, and contrast quantity >100 mL did not. PRL proved to be the most important RF for CIN, whereas HF was the only independent RF for high-risk CIN patients. CONCLUSIONS The incidence of CIN coincides with the results in the literature. PRL, HF, and age ≥65 years resulted in independent RFs for CIN; more and larger trials are needed to evaluate DM, anemia, and contrast quantity related to their impact on CIN. High-risk patients with CIN represent the most problematic patients of this pathology.
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Affiliation(s)
- Naltin Shuka
- Cardiovascular Medicine, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Endri Hasimi
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Artan Kristo
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Leonard Simoni
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Taulant Gishto
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Ervina Shirka
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | | | - Artan Goda
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
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Del Rio-Pertuz G, Leelaviwat N, Mekraksakit P, Benjanuwattra J, Nugent K, Ansari MM. Association between elevated CHA2DS2-VASC score and contrast-induced nephropathy among patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Acta Cardiol 2023; 78:922-929. [PMID: 37171278 DOI: 10.1080/00015385.2023.2209406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Promising results with the CHA2DS2-VASc risk score (CVRS) have been reported for the prediction of contrast-induced nephropathy (CIN). The aim of this study is to consolidate all the data available and examine the association between elevated CVRS and the incidence of CIN in patients undergoing percutaneous coronary intervention (PCI). METHODS We systematically searched PubMed, Embase, and Scopus for abstracts and full-text articles from inception to May 2022. Studies were included if they evaluated the association between a high CVRS and the incidence of CIN in patients undergoing PCI. Data were integrated using the random-effects, generic inverse variance method of DerSimonian and Laird. Prospero registration: CRD42022334065. RESULTS Seven studies from 2016 to 2021 with a total of 7,401 patients were included. In patients undergoing PCI, a high CVRS (≥2: Odds ratio [OR]:2.98, 95% confidence interval [95% CI] 2.25-3.94, p < .01, I2 = 1%, ≥3: OR 4.46, 95% CI 2.27-8.78, p < .01, I2=56% and ≥4: OR:2.75, 95% CI 1.76-4.30, p < .01, I2 = 11%) was significantly associated with an increase incidence for CIN. Subgroup analyses were done in patients with acute coronary syndrome, and association with CIN remained statistically significant (≥2: OR 2.93, 95% CI 2.11-4.07, p < .01, I2=22%and ≥4: OR:2.24, 95% CI 1.36-3.69, p < .01, I2 = 0%,). CONCLUSION In patients undergoing PCI, an elevated CVRS is associated with an increased risk for CIN. More rigorous studies are needed to clarify this association and to identify strategies to reduce CIN.
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Affiliation(s)
- Gaspar Del Rio-Pertuz
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Natnicha Leelaviwat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Poemlarp Mekraksakit
- Department of Internal Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - Juthipong Benjanuwattra
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mohammad M Ansari
- Department of Internal Medicine, Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Khandy AH, Shiekh R, Nabi T, Sheikh MT, Sheikh RY. Incidence, Determinants, and Outcome of Contrast-induced Acute Kidney Injury following Percutaneous Coronary Intervention at a Tertiary Care Hospital. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:214-223. [PMID: 38231716 DOI: 10.4103/1319-2442.393994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) is the common cause of in-hospital acquired AKI and is associated with in-hospital mortality and prolonged hospital stay. We studied the incidence of CI-AKI after PCI, determinants of CI-AKI, and also assessed their length of hospital stay, in-hospital mortality, and need for dialysis. This was a hospital-based prospective observational study done on 204 adult subjects, who were candidates for PCI, at a tertiary care center in North India. Various clinical and biochemical parameters were monitored. Renal function was estimated at admission and 48 and 72 h after PCI. The incidence of CI-AKI post-PCI was 12.7%. Factors predicting the CI-AKI post-PCI on multiple logistic regression analysis are as follows: age ≥70 years, chronic kidney disease (CKD), hypotension, acute decompensated heart failure (ADHF), severe left ventricular systolic dysfunction (LVSD), and intra-aortic balloon pump (IABP) support. Contrast medium volume ≥200 mL and baseline estimated glomerular filtration rate <60 mL/min/1.73 m2 were significantly found to increase the risk of CI-AKI. Patients developing CI-AKI had significantly longer duration of hospital stay (6.4 ± 1.8 days vs. 3.1 ± 0.9 days; P <0.001). 15.4% of CI-AKI patients needed dialysis. In-hospital mortality was significantly higher in patients with CI-AKI (P <0.001). CI-AKI is a common complication following PCI, especially if the patient is elderly, has impaired renal function, hypotension, ADHF, severe LVSD and requires IABP support. The incidence of CI-AKI increases with the increases in contrast volume above 200 mL. The development of CI-AKI leads to a longer duration of hospital stay and increases in-hospital mortality.
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Affiliation(s)
- Aashaq Hussain Khandy
- Department of Cardiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
| | - Rayees Shiekh
- Department of Cardiology, Batra Hospital and Medical Research Center, New Delhi, India
| | - Tauseef Nabi
- Department of Endocrinology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
| | - Mohamad Tahir Sheikh
- Department of Cardiology, Superspeciality Hospital GMC, Srinagar, Jammu and Kashmir, India
| | - Rayees Yousuf Sheikh
- Department of Medicine, Subdivision Nephrology, SRMS IMS Bareilly, Uttar Pradesh, India
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He C, Zhang S, He H, You Z, Lin X, Zhang L, Chen J, Lin K. Predictive value of plasma volume status for contrast-induced nephropathy in patients with heart failure undergoing PCI. ESC Heart Fail 2021; 8:4873-4881. [PMID: 34704403 PMCID: PMC8712793 DOI: 10.1002/ehf2.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 11/09/2022] Open
Abstract
Aims Contrast‐induced nephropathy remains a common complication of coronary procedure and increases poor outcomes, especially in patients with heart failure. Plasma volume expansion relates to worsening prognosis of heart failure. We hypothesized that calculated plasma volume status (PVS) might provide predictive utility for contrast‐induced nephropathy in patients with heart failure undergoing elective percutaneous coronary intervention (PCI). Methods and results We enrolled 441 patients with heart failure undergoing elective PCI from 2012 to 2018. Pre‐procedural estimated PVS by the Duarte's formula (Duarte‐ePVS) and Kaplan–Hakim formula (KH‐ePVS) were calculated for all patients. CIN was defined as an absolute serum creatinine (SCr) increase ≥0.5 mg/dL or a relative increase ≥25% compared with the baseline value within 48 h of contrast medium exposure. We assessed the association between PVS and CIN in patients with heart failure undergoing elective PCI. In 441 patients, 28 (6.3%) patients developed CIN. The median Duarte‐ePVS was 4.44 (3.87, 5.13) and the median KH‐ePVS was −0.03 (−0.09, 0.05). The best cutoff values for Duarte‐ePVS and KH‐ePVS to predict CIN were 4.64 (with 78.6% sensitivity and 61.7% specificity) and 0.04 (with 64.5% sensitivity and 75.5% specificity), respectively. After adjusting for potential confounding variables, KH‐ePVS > 0.04 [odds ratio (OR) 2.685, 95% confidence interval (CI) 1.012–7.123, P = 0.047] remained significantly associated with CIN whereas Duarte‐ePVS was not. Conclusions Pre‐procedural KH‐ePVS is an independent risk factor for CIN in patients with heart failure undergoing elective PCI. The best cutoff point of KH‐ePVS for predicting CIN was 0.04.
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Affiliation(s)
- Chen He
- Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Sicheng Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
| | - Haoming He
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
| | - Zhebin You
- Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Xueqin Lin
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
| | - Liwei Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
| | - Jiankang Chen
- Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Kaiyang Lin
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
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Xu T, Lin M, Shen X, Wang M, Zhang W, Zhao L, Li D, Luan Y, Zhang W. Association of the classification and severity of heart failure with the incidence of contrast-induced acute kidney injury. Sci Rep 2021; 11:15348. [PMID: 34321588 PMCID: PMC8319404 DOI: 10.1038/s41598-021-94910-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/16/2021] [Indexed: 01/02/2023] Open
Abstract
Congestive heart failure (HF) is a known risk factor of contrast-induced acute kidney injury (CI-AKI). However, the relationship of the classification and severity of HF with CI-AKI remains under-explored. From January 2009 to April 2019, we recruited patients undergoing elective PCI who had complete pre- and post-operative creatinine data. According to the levels of ejection fraction (EF), HF was classified as HF with reduced EF (HFrEF) [EF < 40%], HF with mid-range EF (HFmrEF) [EF 40–49%] and HF with preserved EF (HFpEF) [EF ≥ 50%]. CI-AKI was defined as an increase of either 25% or 0.5 mg/dL (44.2 μmoI/L) in serum baseline creatinine level within 72 h following the administration of the contrast agent. A total of 3848 patients were included in the study; mean age 67 years old, 33.9% females, 48.1% with HF, and 16.9% with CI-AKI. In multivariate logistic regression analysis, HF was an independent risk factor for CI-AKI (OR 1.316, p value < 0.05). Among patients with HF, decreased levels of EF (OR 0.985, p value < 0.05) and elevated levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) (OR 1.168, p value < 0.05) were risk factors for CI-AKI. These results were consistent in subgroup analysis. Patients with HFrEF were more likely to develop CI-AKI than those with HFmrEF or HFpEF (OR 0.852, p value = 0.031). Additionally, lower levels of EF were risk factors for CI-AKI in the HFrEF and HFmrEF groups, but not in the HFpEF group. NT-proBNP was an independent risk factor for CI-AKI in the HFrEF, HFmrEF and HFpEF groups. Elevated levels of NT-proBNP are independent risk factors for CI-AKI irrespective of the classification of HF. Lower levels of EF were risk factors for CI-AKI in the HFrEF and HFmrEF groups, but not in the HFpEF group.
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Affiliation(s)
- Tian Xu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
| | - Maoning Lin
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
| | - Xiaohua Shen
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
| | - Min Wang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
| | - Wenjuan Zhang
- Department of Information Technology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Liding Zhao
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
| | - Duanbin Li
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
| | - Yi Luan
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, People's Republic of China. .,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China.
| | - Wenbin Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, People's Republic of China. .,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China.
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Radio-contrast medium exposure and dialysis risk in patients with chronic kidney disease and congestive heart failure: A case-only study. Int J Cardiol 2020; 324:199-204. [PMID: 32926946 DOI: 10.1016/j.ijcard.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/05/2020] [Accepted: 09/07/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Dialysis for end stage renal disease is considered a major public health challenge. Pre-existing chronic kidney disease (CKD) and congestive heart failure (CHF) may be independent risk factors for contrast-induced acute kidney injury. The aim of this study is to investigate dialysis risk in patients with CKD and CHF after radio-contrast medium exposure or coronary catheterization. METHOD This case-crossover design used the Health Insurance Database to identify incident dialysis patients with CKD and CHF. Patients themselves in 6 months ago serve as their own controls. This prevents selection bias in the control group, such as healthy volunteer bias and confounding bias. Conditional logistic regression model was used to estimate the risk of dialysis shortly after radio-contrast medium exposure. RESULTS In total, 36,709 patients with CKD and CHF underwent dialysis after radio-contrast medium exposure. At 1 week, the odds ratio (OR) for dialysis was 4.49 (95% Confidence Interval: 3.99-5.05). The ORs for acute-temporary (N = 23,418) and chronic dialysis (N = 13,291) were 5.57 (4.83-6.42) and 2.37 (1.90-2.95) after radio-contrast medium exposure, respectively. The ORs for dialysis after radio-contrast medium exposure in advanced CKD patients (N = 12,030) were 3.25 (2.53-4.19) and 4.85 (4.24-5.54) in early CKD patients (N = 24,679). The ORs for dialysis after coronary catheterization in patients with CKD and CHF was 3.75 (2.57-5.48). CONCLUSIONS In this study, the clinical risk for acute-temporary or chronic dialysis was significantly high when the bias was fully considered. We need strategies to reduce the subsequent risk of dialysis after radio-contrast medium exposure, especially in patients with CKD and CHF.
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Davenport MS, Perazella MA, Yee J, Dillman JR, Fine D, McDonald RJ, Rodby RA, Wang CL, Weinreb JC. Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020; 294:660-668. [PMID: 31961246 DOI: 10.1148/radiol.2019192094] [Citation(s) in RCA: 235] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intravenous iodinated contrast media are commonly used with CT to evaluate disease and to determine treatment response. The risk of acute kidney injury (AKI) developing in patients with reduced kidney function following exposure to intravenous iodinated contrast media has been overstated. This is due primarily to historic lack of control groups sufficient to separate contrast-induced AKI (CI-AKI; ie, AKI caused by contrast media administration) from contrast-associated AKI (CA-AKI; ie, AKI coincident to contrast media administration). Although the true risk of CI-AKI remains uncertain for patients with severe kidney disease, prophylaxis with intravenous normal saline is indicated for patients who have AKI or an estimated glomerular filtration rate less than 30 mL/min/1.73 m2 who are not undergoing maintenance dialysis. In individual high-risk circumstances, prophylaxis may be considered in patients with an estimated glomerular filtration rate of 30-44 mL/min/1.73 m2 at the discretion of the ordering clinician. This article is a simultaneous joint publication in Radiology and Kidney Medicine. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article.
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Affiliation(s)
- Matthew S Davenport
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Mark A Perazella
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Jerry Yee
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Jonathan R Dillman
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Derek Fine
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Robert J McDonald
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Roger A Rodby
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Carolyn L Wang
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Jeffrey C Weinreb
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
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10
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Davenport MS, Perazella MA, Yee J, Dillman JR, Fine D, McDonald RJ, Rodby RA, Wang CL, Weinreb JC. Use of Intravenous Iodinated Contrast Media in Patients With Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Kidney Med 2020; 2:85-93. [PMID: 33015613 PMCID: PMC7525144 DOI: 10.1016/j.xkme.2020.01.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/08/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022] Open
Abstract
Intravenous iodinated contrast media are commonly used with CT to evaluate disease and to determine treatment response. The risk of acute kidney injury (AKI) developing in patients with reduced kidney function following exposure to intravenous iodinated contrast media has been overstated. This is due primarily to historic lack of control groups sufficient to separate contrast-induced AKI (CI-AKI; ie, AKI caused by contrast media administration) from contrast-associated AKI (CA-AKI; ie, AKI coincident to contrast media administration). Although the true risk of CI-AKI remains uncertain for patients with severe kidney disease, prophylaxis with intravenous normal saline is indicated for patients who have AKI or an estimated glomerular filtration rate less than 30 mL/min/1.73 m2 who are not undergoing maintenance dialysis. In individual high-risk circumstances, prophylaxis may be considered in patients with an estimated glomerular filtration rate of 30-44 mL/min/1.73 m2 at the discretion of the ordering clinician.
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Affiliation(s)
- Matthew S Davenport
- Department of Radiology, Michigan Medicine, Ann Arbor, MI.,Department of Urology, Michigan Medicine, Ann Arbor, MI.,Michigan Radiology Quality Collaborative, Ann Arbor, MI.,American College of Radiology, Reston, VA
| | - Mark A Perazella
- National Kidney Foundation, New York, NY.,Section of Nephrology, Yale University School of Medicine, New Haven, CT
| | - Jerry Yee
- Department of Nephrology, Henry Ford Health System, Detroit, MI
| | - Jonathan R Dillman
- American College of Radiology, Reston, VA.,Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, OH
| | - Derek Fine
- National Kidney Foundation, New York, NY.,Department of Nephrology, Johns Hopkins Medicine, Baltimore, MD
| | - Robert J McDonald
- American College of Radiology, Reston, VA.,Department of Radiology, Mayo Clinic, Rochester, MN
| | - Roger A Rodby
- National Kidney Foundation, New York, NY.,Department of Nephrology, Rush University Medical Center, Chicago, IL
| | - Carolyn L Wang
- American College of Radiology, Reston, VA.,Department of Radiology, University of Washington, Seattle, WA
| | - Jeffrey C Weinreb
- American College of Radiology, Reston, VA.,Section of Nephrology, Yale University School of Medicine, New Haven, CT.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
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11
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Hasselbalch RB, Pries-Heje M, Engstrøm T, Sandø A, Heitmann M, Pedersen F, Schou M, Mickley H, Elming H, Steffensen R, Koeber L, Iversen KK. Coronary risk stratification of patients with newly diagnosed heart failure. Open Heart 2019; 6:e001074. [PMID: 31673386 PMCID: PMC6802977 DOI: 10.1136/openhrt-2019-001074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/18/2019] [Accepted: 09/12/2019] [Indexed: 01/07/2023] Open
Abstract
Objective Coronary artery disease (CAD) is frequent in patients with newly diagnosed heart failure (HF). Multislice CT (MSCT) is a non-invasive alternative to coronary angiography (CAG) suggested for patients with a low-to-intermediate risk of CAD. No established definition of such patients exists. Our purpose was to develop a simple score to identify as large a group as possible with a suitable pretest risk of CAD. Methods Retrospective study of patients in Denmark undergoing CAG due to newly diagnosed HF from 2010 to 2014. All Danish patients were registered in two databases according to geographical location. We used data from one registry and multiple logistic regression with backwards elimination to find predictors of CAD and used the derived OR to develop a clinical risk score called the CT-HF score, which was subsequently validated in the other database. Results The main cohort consisted of 2171 patients and the validation cohort consisted of 2795 patients with 24% and 27% of patients having significant CAD, respectively. Among significant predictor, the strongest was extracardiac arteriopathy (OR 2.84). Other significant factors were male sex, smoking, hyperlipidaemia, diabetes mellitus, angina and age. A proposed cut-off of 9 points identified 61% of patients with a 15% risk of having CAD, resulting in an estimated savings of 15% of the cost and 21% of the radiation. Conclusions A simple score based on clinical risk factors could identify HF patients with a low risk of CAD; these patients may have benefitted from MSCT as a gatekeeper for CAG.
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Affiliation(s)
| | - Mia Pries-Heje
- Department of Cardiology, Herlev og Gentofte Hospital, Herlev, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Sandø
- Department of Cardiology, Herlev og Gentofte Hospital, Herlev, Denmark
| | - Merete Heitmann
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev og Gentofte Hospital, Herlev, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Hanne Elming
- Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark
| | - Rolf Steffensen
- Department of Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Lars Koeber
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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12
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Abstract
STUDY OBJECTIVE Computed tomography (CT) is an important imaging modality in diagnosing a variety of disorders. Although systolic heart failure is a well-known risk factor for postcontrast acute kidney injury (PC-AKI), few studies have evaluated the association between diastolic dysfunction and PC-AKI. Therefore, the aim of our study was to investigate whether PC-AKI occurs more likely in patients with diastolic dysfuction. METHODS This retrospective study was conducted by collecting the data of patients who visited an emergency medical center between January 2008 and December 2014. Patients who underwent contrast-enhanced CT (CECT) in the emergency department and had undergone echocardiography within 1 month of CECT were included. We defined PC-AKI as an elevation in the serum creatinine level of ≥0.5 mg/dL or ≥25% within 72 hours after CECT. RESULTS We included 327 patients, aged 18 years and older, who had a CECT scan and underwent an echocardiography within 1 month of the CECT scan at our institute over 20 years. The mean value of estimated glomerular filtration rate and E/E (early left ventricular filling velocity to early diastolic mitral annular velocity ratio) was 51.55 ± 7.66 mL·min·1.73 m and 11.56 ± 5.33, respectively. A total of 32 patients (9.79%) developed PC-AKI. The prevalence of diabetes mellitus and chronic kidney disease was significantly higher in the PC-AKI group than in the non-PC-AKI group. Echocardiographic findings revealed that E/E was significantly increased in patients with PC-AKI. The logistic regression analysis showed that a higher E/E value (odds ratio [OR] 5.39, 95% confidence interval [CI] 1.51-25.23, P = .015) was a significant risk factor for PC-AKI. CONCLUSION This study demonstrated that, among the echocardiographic variables, E/E was an independent predictor of PC- AKI. This, in turn, suggests that diastolic dysfunction may be a useful parameter in PC-AKI risk stratification.
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Affiliation(s)
| | | | - Hyuk-Hoon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, 16499, Suwon, Republic of Korea
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13
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Nemoto T, Minami Y, Sato T, Muramatsu Y, Kakizaki R, Hashimoto T, Oikawa J, Fujiyoshi K, Meguro K, Shimohama T, Tojo T, Ako J. Contrast Volume and Decline in Kidney Function in Optical Coherence Tomography-Guided Percutaneous Coronary Intervention. Int Heart J 2019; 60:1022-1029. [PMID: 31484858 DOI: 10.1536/ihj.18-565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) may increase contrast volume. However, the impact of OCT-guided PCI on the decline in kidney function (DKF) in actual clinical practice remains unclear.Among 1,003 consecutive patients who underwent either OCT-guided or intravascular ultrasound (IVUS)-guided PCI in our institute, we identified 202 propensity score-matched pairs adjusted by baseline factors. The incidence of DKF was compared between the OCT-guided PCI group and the IVUS-guided PCI group. DKF was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or a relative increase of ≥ 25% over baseline within 48 hours (acute DKF) or 1 month (sustained DKF) after PCI.Baseline characteristics, including the prevalence of chronic kidney disease (54% versus 46%, P = 0.09), were comparable between the OCT- and IVUS-guided PCI groups except for the age. The contrast volume was comparable between the two groups (153 ± 56 versus 144 ± 60 mL, P = 0.09), although it was significantly greater in the OCT-guided PCI group in patients with acute coronary syndrome (ACS; 175 ± 55 versus 159 ± 43 mL, P = 0.04). The incidence of acute DKF (0.5% versus 2.5%, P = 0.22) and sustained DKF (5.0% versus 10.4%, P = 0.31) was comparable between the two groups. Multivariate analysis demonstrated that ACS (odds ratio 4.74, 95% confidence interval 2.72-8.25, P < 0.001) was a predictor of sustained DKF.Compared with IVUS-guided PCI, OCT-guided PCI did not increase the incidence of DKF in actual clinical practice, although the increased contrast volume was observed in ACS cases.
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Affiliation(s)
- Teruyoshi Nemoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Toshimitsu Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yusuke Muramatsu
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Ryota Kakizaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takuya Hashimoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Kazuhiro Fujiyoshi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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14
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Qian G, Liu CF, Guo J, Dong W, Wang J, Chen Y. Prevention of contrast-induced nephropathy by adequate hydration combined with isosorbide dinitrate for patients with renal insufficiency and congestive heart failure. Clin Cardiol 2019; 42:21-25. [PMID: 30054906 DOI: 10.1002/clc.23023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/23/2018] [Accepted: 07/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adequate hydration remains the mainstay of contrast-induced nephropathy prevention, and nitrates could reduce cardiac preload. HYPOTHESIS This study aimed to explore the adequate hydration with nitrates for patients with chronic kidney disease (CKD) and congestive heart failure (CHF) to reduce the risk of contrast-induced nephropathy (CIN) and at the same time avoid the acute heart failure. METHODS Three hundred and ninty-four consecutive patients with CKD and CHF undergoing coronary procedures were randomized to either adequate hydration with nitrates (n = 196) or to routine hydration (control group; n = 198). The adequate hydration group received continuous intravenous infusion of isosorbide dinitrate combined with intravenous infusion of isotonic saline at a rate of 1.5 mL/kg/h during perioperative period. The definition of CIN was a 25% or 0.5 mg/dL rise in serum creatinine over baseline. This trial is registered with www.clinicaltrials.gov, number NCT02718521. RESULTS Baseline characteristics were well-matched between the two groups. CIN occurred less frequently in adequate hydration group than the control group (12.8% vs 21.2%; P = 0.018). The incidence of acute heart failure did not differ between the two groups (8 [4.08%] vs 6[3.03%]; P = 0.599). Cumulative major adverse events (death, myocardial infarction, stoke, hospitalization for acute heart failure) during the 90-day follow-up were lower in the adequate hydration with nitrates group (P = 0.002). CONCLUSIONS Adequate hydration with nitrates can safely and effectively reduce the risk of CIN in patients with CKD and CHF.
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Affiliation(s)
- Geng Qian
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chang-Fu Liu
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jun Guo
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wei Dong
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jin Wang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
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15
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Ye Z, Lu H, Su Q, Xian X, Li L. Effect of ligustrazine on preventing contrast-induced nephropathy in patients with unstable angina. Oncotarget 2017; 8:92366-92374. [PMID: 29190922 PMCID: PMC5696188 DOI: 10.18632/oncotarget.21310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Our purpose was to assess the effect of ligustrazine in the prevention of contrast-induced nephropathy (CIN) in patients with unstable angina (UA). Methods 148 patients with UA undergoing coronary angiography and/or percutaneous coronary intervention (PCI) were selected for observation; the patients were divided into a control group (group A, n=74) and a ligustrazine group (group B, n=74). Group A was given routine treatment, while group B was given routine treatment combined with ligustrazine. Serum creatinine (Scr), cystatin C and glomerular filtration rate (eGFR) concentrations were measured before and 1 day, 2 days and 3 days after treatment, and the incidence of contrast-induced nephropathy (CIN) and major cardiovascular events (MACE) were observed in both groups. Results The Scr, Cystatin C and eGRF levels in group B were better than in group A after 1 day (OR: 2.64, 95% CI: 2.47-4.98; OR: 2.66, 95% CI: 2.62-5.77; OR: 4.02, 95% CI: 3.02-5.53, respectively), 2 days (OR: 3.58, 95% CI: 2.41-4.92; OR: 2.92, 95% CI: 2.83-5.02; OR: 3.28, 95% CI: 3.24-5.14, respectively) and 3 days of treatment (OR: 3.26, 95% CI: 2.17-4.35; OR: 2.85, 95% CI: 2.26-4.02; OR: 3.19, 95% CI: 2.53-4.34, respectively). The incidence of CIN (9.26% vs 16.67%) and MACE (7.41% vs 18.51%) of group B were significantly lower than in group A (P<0.05). Conclusions Our study suggests that ligustrazine can reduce CIN and MACE in patients with UA when undergoing coronary angiography and/or PCI.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China.,Guangxi Medical University, Nanning, Guangxi, China
| | - Haili Lu
- Guangxi Medical University, Nanning, Guangxi, China
| | - Qiang Su
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Xinhua Xian
- Guangxi Medical University, Nanning, Guangxi, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
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16
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Wang K, Li HL, Bei WJ, Guo XS, Chen SQ, Islam SMS, Chen JY, Liu Y, Tan N. Association of left ventricular ejection fraction with contrast-induced nephropathy and mortality following coronary angiography or intervention in patients with heart failure. Ther Clin Risk Manag 2017; 13:887-895. [PMID: 28769566 PMCID: PMC5529088 DOI: 10.2147/tcrm.s137654] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Left ventricular ejection fraction (LVEF) is the most widely used parameter to evaluate the cardiac function in patients with heart failure (HF). However, the association between LVEF and contrast-induced nephropathy (CIN) is still controversial. Therefore, the aim of this study is to evaluate the association of LVEF with CIN and long-term mortality following coronary angiography (CAG) or intervention in patients with HF. Methods We analyzed 1,647 patients with HF (New York Heart Association [NYHA] or Killip class >1) undergoing CAG or intervention, including 207 (12.57%) patients with reduced LVEF (HFrEF), 238 (14.45%) with mid-range LVEF (HFmrEF) and 1,202 (72.98%) with preserved LVEF (HFpEF). CIN was defined as an absolute increase of ≥0.5 mg/dL or a relative increase of ≥25% from baseline serum creatinine within 48–72 h after contrast medium exposure. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to identify the association between LVEF, CIN and long-term mortality, respectively. Results Overall, 225 patients (13.7%) developed CIN. Individuals with lower LVEF were more likely to develop CIN (HFrEF, HFmrEF and HFpEF: 18.4%, 21.8% and 11.2%, respectively; P<0.001), but without a significant trend after adjusting for the confounding factors (HFrEF vs HFpEF: odds ratio [OR] =1.01; HFmrEF vs HFpEF: OR =1.31; all P>0.05). However, advanced HF (NYHA class >2 or Killip class >1) was an independent predictor of CIN (adjusted OR =1.54, 95% confidence interval [CI], 1.07–2.22; P=0.019). During the mean follow-up of 2.3 years, reduced LVEF (HFrEF group) was significantly associated with increased mortality (HFrEF vs HFpEF: adjusted hazard ratio =2.88, 95% CI, 1.77–4.69; P<0.001). Conclusion In patients with HF undergoing CAG or intervention, not worsened LVEF but advanced HF was associated with an increased risk of CIN. In addition, reduced LVEF was an independent predictor of long-term mortality following cardiac catheterization.
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Affiliation(s)
- Kun Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Hua-Long Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Wei-Jie Bei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Xiao-Sheng Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Shi-Qun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | | | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
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Song T, Song M, Ge Z, Li Y, Shi P, Sun M. Comparison of the nephrotoxic effects of iodixanol versus iohexol in patients with chronic heart failure undergoing coronary angiography or angioplasty. J Interv Cardiol 2017; 30:281-285. [PMID: 28421628 DOI: 10.1111/joic.12381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/17/2017] [Accepted: 03/24/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this clinical trial is to compare iodixanol with iohexol for the incidence of contrast-induced nephropathy in patients with chronic heart failure with reduced ejection fraction who are currently undergoing coronary angiography or angioplasty. METHODS The clinical trial included 220 consecutive patients with chronic heart failure with reduced ejection fraction undergoing coronary angiography or angioplasty. Study participants were administered either iodixanol (n = 110) or iohexol (n = 110). The primary study endpoint was the incidence of contrast-induced nephropathy within 72 h after the procedure. The secondary endpoints were to determine the peak increase in serum creatinine levels and Cystatin C, and the peak decrease in estimated glomerular filtration rate at 72 h post-contrast medium. RESULTS Baseline demographic and clinical characteristics of the patients were similar between the two groups. Our study showed that the overall incidence of contrast induced nephropathy in patients with chronic heart failure was 20.9%. The incidence of contrast induced nephropathy was significantly lower in iodixanol group than in iohexol group (29.1% vs 12.7%, P = 0.041). The peak increase in serum creatinine levels and the peak decrease in estimated glomerular filtration rate after the procedure were statistically significant between the two groups. Moreover, there was statistically significance in the peak increase of Cystatin C levels after the procedure. CONCLUSIONS In patients with chronic heart failure with reduced ejection fraction who are currently undergoing coronary angiography with or without percutaneous coronary intervention, the iso-osmolar contrast iodixanol was associated with a lower incidence of contrast induced nephropathy than low-osmolar contrast iohexol.
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Affiliation(s)
- Tao Song
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Department of Cardiology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Zaozhuang, Shandong, China
| | - Min Song
- Department of Cardiology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Zaozhuang, Shandong, China
| | - Zhiming Ge
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yong Li
- Department of Cardiology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Zaozhuang, Shandong, China
| | - Peimiao Shi
- Department of Cardiology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Zaozhuang, Shandong, China
| | - Menghan Sun
- Department of Cardiology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Zaozhuang, Shandong, China
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18
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Reinstadler SJ, Kronbichler A, Reindl M, Feistritzer HJ, Innerhofer V, Mayr A, Klug G, Tiefenthaler M, Mayer G, Metzler B. Acute kidney injury is associated with microvascular myocardial damage following myocardial infarction. Kidney Int 2017; 92:743-750. [PMID: 28412022 DOI: 10.1016/j.kint.2017.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
Acute kidney injury (AKI) is a frequent complication in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention. However, the pathophysiology of AKI in this setting is complex and goes beyond the administration of contrast media. Studies assessing the impact of infarct characteristics on AKI are currently lacking. Therefore, we investigated the association of AKI with myocardial as well as microvascular injury in an initial total of 361 consecutive STEMI patients treated by primary percutaneous coronary intervention. Of these, 318 patients were included in final analysis. Serum creatinine was measured on admission as well as 24, 48, and 72 hours thereafter with AKI defined as an increase in serum creatinine of 0.3 mg/dl or more. Cardiac magnetic resonance (CMR) scans were performed in the first week after infarction, with microvascular injury visualized by late gadolinium enhancement CMR defined as any region of hypoenhancement within the hyperenhanced area of infarction. Sixteen patients developed AKI. They showed significantly lower left ventricular ejection fraction (45[interquartile range 40-52]% vs. 54[47-59]%), larger infarct size (21[15-35]% vs. 12[7-22]%) of left ventricular myocardial mass, and more frequent microvascular injury (81 vs. 46%) than those free of AKI. Meaningfully, in multivariate analysis including all CMR data, microvascular injury was the sole independent predictor of AKI (odds ratio 6.74, 95% confidence interval of 1.49-30.43). Thus, among revascularized STEMI patients, the presence of microvascular injury assessed by CMR was independently associated with an increased risk of AKI. This suggests a potential pathophysiological link between cardiac microvascular disease and renal injury following STEMI.
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Affiliation(s)
- Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Andreas Kronbichler
- University Clinic of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Veronika Innerhofer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Martin Tiefenthaler
- University Clinic of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Gert Mayer
- University Clinic of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria.
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Lian D, Liu Y, Liu YH, Li HL, Duan CY, Yu DQ. Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing Elective Coronary Angiography. Int Heart J 2017; 58:197-204. [PMID: 28320991 DOI: 10.1536/ihj.16-129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To establish a scoring model to predict the risk of contrast-induced nephropathy (CIN) in elderly patients undergoing elective coronary angiography (CAG).A total of 1286 patients aged > 65 years who had undergone elective CAG between August 2009 and February 2013 were enrolled in this study. They were randomly (3:2) assigned to a development (n = 756) or validation dataset (n = 530). Independent predictors of CIN were identified by using logistic regression and were assigned a weighted integer, which was used to establish a score model.CIN incidence in the development set was 6.3%. The risk score model contained 3 variables (with the weighted integer): age > 75 years (1.5), creatinine clearance (CrCl) < 60 mL/minute (1), and congestive heart failure (CHF) (1.5). CIN incidence was 3.1%, 9.1%, and 29.0% in the low-risk group (≤ 1), moderate risk group (1 - 3), and high-risk group (≥ 3), respectively. The risk model demonstrated good prediction value in the development (c-statistic = 0.727) and validation (c-statistic = 0.695) datasets. Compared to the non-CIN group, the CIN group had a significantly higher rate of inhospital major adverse cardiac events (P < 0.01).The risk score model with 3 variables, namely age > 75 years, CrCl < 60 mL/minute, and CHF, is a clinical prediction tool for CIN in elderly patients before elective CAG. CIN is one of the independent risk factors of major adverse cardiac events (MACE).
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Affiliation(s)
- Dan Lian
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital
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20
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Predictive Value of CHA2DS2-VASC Score for Contrast-Induced Nephropathy After Percutaneous Coronary Intervention for Acute Coronary Syndrome. Am J Cardiol 2017; 119:819-825. [PMID: 28040187 DOI: 10.1016/j.amjcard.2016.11.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 01/18/2023]
Abstract
The CHA2DS2-VASC score, used for embolic risk stratification in atrial fibrillation (AF), has been reported recently to predict adverse clinical outcomes in patients with acute coronary syndrome (ACS), regardless of having AF. We investigated the correlation between the CHA2DS2-VASC score and contrast-induced nephropathy (CIN) in patients with ACS who underwent urgent percutaneous coronary intervention (PCI). A total of 1,408 patients were enrolled in the study. The CHA2DS2-VASC score was calculated for each patient. Based on the receiver operating characteristic analysis, the study population was divided into 2 groups: CHA2DS2-VASC score ≤3 group (n = 944) and CHA2DS2-VASC score ≥4 group (n = 464). Patients were then reallocated to 2 groups according to the presence or absence of CIN. CIN was defined as a rise in serum creatinine >0.5 mg/dl or >25% increase in baseline within 72 hours after PCI. Overall, 159 cases (11.3%) of CIN were diagnosed. Receiver operating characteristic curve analysis revealed good diagnostic value of CHA2DS2-VASC score in predicting CIN (area under the curve 0.769, 95% confidence interval 0.733 to 0.805; p <0.001). When patients with a CHA2DS2-VASC score of ≥4 were compared with those with a CHA2DS2-VASC score of ≤3, patients with high score had a higher frequency of CIN (23.9% vs 5.1%; p <0.001), and multivariate analysis identified the CHA2DS2-VASC score of ≥4 as an independent predictor of CIN. In conclusion, CHA2DS2-VASC score can be used as a new, simple, and reliable tool to predict CIN in patients with ACS who underwent urgent PCI.
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21
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Wang K, Li HL, Chen LL, Bei WJ, Lin KY, Smyth B, Chen SQ, Guo XS, Guo W, Liu YH, Chen PY, Chen JY, Chen KH, Liu Y, Tan N. Association of N-terminal pro-brain natriuretic peptide with contrast-induced acute kidney injury and long-term mortality in patients with heart failure and mid-range ejection fraction: An observation study. Medicine (Baltimore) 2017; 96:e6259. [PMID: 28272231 PMCID: PMC5348179 DOI: 10.1097/md.0000000000006259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The potential value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for contrast-induced acute kidney injury (CI-AKI) in patients with heart failure and mid-range ejection fraction (HFmrEF) is unclear. We investigated whether NT-proBNP is associated with CI-AKI and long-term mortality following elective cardiac catheterization in patients with HFmrEF.A total of 174 consecutive patients with HFmrEF undergoing elective coronary angiography or intervention were enrolled. The primary endpoint was the development of CI-AKI, defined as an absolute increase of ≥0.3 mg/dL or ≥ 50% from baseline serum creatinine with 48 hours after contrast medium exposure. Receiver-operating characteristic curve analysis was conducted, and Youden index was used to determine the best cutoff NT-proBNP value. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to identify the independent risk factors for CI-AKI and long-term mortality, respectively.The incidence of CI-AKI was 12.1%. Patients with CI-AKI had higher NT-proBNP values than those without (4373[1561.9-7470.5] vs 1303[625.2-2482.3], P = 0.003). Receiver-operating characteristic curve revealed that NT-proBNP was not significantly different from the Mehran risk score in predicting CI-AKI (area under the curve [AUC] = 0.723 vs 0.767, P = 0.516). The best cutoff NT-proBNP value for CI-AKI was 3299 pg/mL, with 70.6% sensitivity and 83.1% specificity. Multivariable analysis demonstrated that NT-proBNP ≥3299 pg/mL is significantly related to CI-AKI (odds ratio = 12.79; 95% confidence interval, 3.18-51.49; P < 0.001). Cox regression analysis showed that NT-proBNP ≥3299 pg/mL is associated with long-term mortality (adjusted hazard ratio = 11.91; 95%CI, 2.16-65.70; P = 0.004) during follow-up.In patients with HFmrEF, NT-proBNP ≥3299 pg/mL is associated with CI-AKI and long-term mortality following elective coronary angiography or intervention.
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Affiliation(s)
- Kun Wang
- Department of Graduate School, Southern Medical University
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Hua-long Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
- School of Medicine, South China University of Technology, Guangzhou, Guangdong
| | - Li-ling Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
- Department of Cardiology, Longyan First Hospital, Affiliated to Fujian Medical University, Fujian
| | - Wei-jie Bei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Kai-yang Lin
- Department of Cardiology, Fujian Cardiovascular Institute, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Brendan Smyth
- The George Institute for Global Health, the University of Sydney, Sydney, NSW, Australia
| | - Shi-qun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Xiao-sheng Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Wei Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Yuan-hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Peng-yuan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
- School of Medicine, South China University of Technology, Guangzhou, Guangdong
| | - Kai-hong Chen
- Department of Cardiology, Longyan First Hospital, Affiliated to Fujian Medical University, Fujian
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
- School of Medicine, South China University of Technology, Guangzhou, Guangdong
| | - Ning Tan
- Department of Graduate School, Southern Medical University
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences
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Does N-terminal pro-brain natriuretic peptide add prognostic value to the Mehran risk score for contrast-induced nephropathy and long-term outcomes after primary percutaneous coronary intervention? Int Urol Nephrol 2016; 48:1675-82. [PMID: 27473154 DOI: 10.1007/s11255-016-1348-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the prognostic value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) in relation to Mehran risk score (MRS) for contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS We prospectively enrolled 283 consecutive patients treated with PPCI for STEMI. NT-proBNP was measured, and the MRS was calculated. The primary end point was CIN, defined as an absolute increase in serum creatinine ≥0.5 mg/dL from baseline within 48-72 h after contrast medium exposure. RESULTS The incidence of CIN was 9.2 %. Patients with CIN had higher NT-proBNP and MRS than those without CIN. The value of NT-proBNP was similar to MRS for CIN (C statistics 0.760 vs. 0.793, p = 0.689). After adjustment for MRS, elevated NT-proBNP (defined as the best cutoff point) was significantly associated with CIN. The addition of elevated NT-proBNP to MRS did not significantly improve the C statistics, over that with the original MRS model (0.833 vs. 0.793, p = 0.256). In addition, similar results were observed for in-hospital and long-term major adverse clinical events. CONCLUSIONS Although NT-proBNP did not add any prognostic value to the MRS model for CIN, NT-proBNP, as a simple biomarker, was similar to MRS, and may be another useful and rapid screening tool for CIN and death risk assessment, identifying subjects who need therapeutic measures to prevent CIN.
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Qian G, Fu Z, Guo J, Cao F, Chen Y. Prevention of Contrast-Induced Nephropathy by Central Venous Pressure–Guided Fluid Administration in Chronic Kidney Disease and Congestive Heart Failure Patients. JACC Cardiovasc Interv 2016; 9:89-96. [DOI: 10.1016/j.jcin.2015.09.026] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/16/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022]
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24
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Lesniak W, Bala MM, Dubiel B, Gajewski P. Acetylcysteine for preventing contrast-induced nephropathy. Hippokratia 2015. [DOI: 10.1002/14651858.cd011228.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Wiktoria Lesniak
- Polish Institute for Evidence Based Medicine; ul. Krakowska 41 Krakow Poland 31-066
| | - Malgorzata M Bala
- Jagiellonian University Medical College; 2nd Department of Internal Medicine; 8 Skawinska St Krakow Poland 31-066
| | - Bozena Dubiel
- Polish Institute for Evidence Based Medicine; ul. Krakowska 41 Krakow Poland 31-066
| | - Piotr Gajewski
- Polish Institute for Evidence Based Medicine; ul. Krakowska 41 Krakow Poland 31-066
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25
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Liu Y, He YT, Tan N, Chen JY, Liu YH, Yang DH, Huang SJ, Ye P, Li HL, Ran P, Duan CY, Chen SQ, Zhou YL, Chen PY. Preprocedural N-terminal pro-brain natriuretic peptide (NT-proBNP) is similar to the Mehran contrast-induced nephropathy (CIN) score in predicting CIN following elective coronary angiography. J Am Heart Assoc 2015; 4:jah3929. [PMID: 25888371 PMCID: PMC4579954 DOI: 10.1161/jaha.114.001410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND N-terminal pro-brain natriuretic peptide (NT-proBNP) has been associated with important risk factors for contrast-induced nephropathy (CIN). However, few studies have investigated the predictive value of NT-proBNP itself. This study investigated whether levels of preprocedural NT-proBNP could predict CIN after elective coronary angiography as effectively as the Mehran CIN score. METHODS AND RESULTS We retrospectively observed 2248 patients who underwent elective coronary angiography. The predictive value of preprocedural NT-proBNP for CIN was assessed by receiver operating characteristic and multivariable logistic regression analysis. The 50 patients (2.2%) who developed CIN had higher Mehran risk scores (9.5 ± 5.1 versus 4.8 ± 3.8), and higher preprocedural levels of NT-proBNP (5320 ± 7423 versus 1078 ± 2548 pg/mL, P<0.001). Receiver operating characteristic analysis revealed that NT-proBNP was not significantly different from the Mehran CIN score in predicting CIN (C=0.7657 versus C=0.7729, P=0.8431). An NT-proBNP cutoff value of 682 pg/mL predicted CIN with 78% sensitivity and 70% specificity. Multivariable analysis suggested that, after adjustment for other risk factors, NT-proBNP >682 pg/mL was significantly associated with CIN (odds ratio: 4.007, 95% CI: 1.950 to 8.234; P<0.001) and risk of death (hazard ratio: 2.53; 95% CI: 1.49 to 4.30; P=0.0006). CONCLUSIONS Preprocedural NT-proBNP >682 pg/mL was significantly associated with the risk of CIN and death. NT-proBNP, like the Mehran CIN score, may be another useful and rapid screening tool for CIN and death risk assessment, identifying subjects who need therapeutic measures to prevent CIN.
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Affiliation(s)
- Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Yi-ting He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.) Department of Cardiology, The First People's Hospital of Shunde, Foshan, China (Y.H.)
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Yuan-hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Da-hao Yang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Shui-jin Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Piao Ye
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Hua-long Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Peng Ran
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Chong-yang Duan
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.D., S.C., P.Y.C.)
| | - Shi-qun Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.D., S.C., P.Y.C.)
| | - Ying-ling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Ping-yan Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.D., S.C., P.Y.C.)
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Shacham Y, Leshem-Rubinow E, Gal-Oz A, Arbel Y, Keren G, Roth A, Steinvil A. Acute Cardio-Renal Syndrome as a Cause for Renal Deterioration Among Myocardial Infarction Patients Treated With Primary Percutaneous Intervention. Can J Cardiol 2015; 31:1240-4. [PMID: 26163472 DOI: 10.1016/j.cjca.2015.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/17/2015] [Accepted: 03/31/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early hemodynamic impairment frequently complicates myocardial injury, however, limited data are present regarding its direct association with acute kidney injury (AKI) after ST segment elevation myocardial infarction (STEMI) in patients who undergo primary percutaneous coronary intervention (PCI). We evaluated the effect of acute hemodynamic derangement on the risk of AKI among STEMI patients who undergo primary PCI. METHODS We performed a retrospective analysis of 1656 consecutive patients admitted with the diagnosis of STEMI between January 2008 and December 2014, and treated with primary PCI. Medical records were reviewed for the presence of various clinical parameters of hemodynamic derangement and for the occurrence of AKI. RESULTS Mean age was 61 ± 13 and 1329 (80%) were men. AKI occurred in 168 patients (10%). Patients with AKI were older, of female sex, with more comorbidities, had longer time to reperfusion, and were more likely to have hemodynamic impairment including critical state, congestive heart failure, life-threatening arrhythmias, and worse left ventricular function (P < 0.001 for all). In a multivariate logistic regression model critical state (odds ratio [OR], 3.33; 95% confidence interval [CI], 1.39-7.8; P = 0.006), reduced left ventricular ejection fraction (OR, 0.95; 95% CI, 0.92-0.99; P = 0.03), congestive heart failure (OR, 2.34; 95% CI, 1.02-5.39; P = 0.04), and a trend for time to coronary reperfusion (OR, 1.01; 95% CI, 1.00-1.01; P = 0.07) emerged as independent predictors of AKI. CONCLUSIONS Among STEMI patients who underwent primary PCI AKI should not be assumed to be solely contrast-induced nephropathy and acute hemodynamic abnormalities should be considered.
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Affiliation(s)
- Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Eran Leshem-Rubinow
- Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Gal-Oz
- Department of Nephrology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Roth
- Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Liu YH, Liu Y, Zhou YL, Yu DQ, He PC, Xie NJ, Li HL, Wei-Guo, Chen JY, Tan N. Association of N-terminal pro-B-type natriuretic peptide with contrast-induced nephropathy and long-term outcomes in patients with chronic kidney disease and relative preserved left ventricular function. Medicine (Baltimore) 2015; 94:e358. [PMID: 25837748 PMCID: PMC4554022 DOI: 10.1097/md.0000000000000358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The aim of the present article was to evaluate the association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) with contrast-induced nephropathy (CIN) and long-term outcomes in patients with chronic kidney disease (CKD) and relative preserved left ventricular function (LVF) undergoing percutaneous coronary intervention (PCI). We prospectively enrolled 1203 consecutive patients with CKD and preserved LVF undergoing elective PCI. The primary end point was the development of CIN, defined as an absolute increase in serum creatinine (SCr) ≥0.5 mg/dL, from baseline within 48 to 72 hours after contrast medium exposure. CIN incidence varied from 2.2% to 5.2%. Univariate logistic analysis showed that lg-NT-pro-BNP was significantly associated with CIN (odds ratio [OR] = 3.93, 95% confidence interval [CI], 2.22-6.97, P < 0.001). Furthermore, lg-NT-pro-BNP remained a significant predictor of CIN (OR = 3.30, 95% CI, 1.57-6.93, P = 0.002), even after adjusting for potential confounding risk factors. These results were confirmed by using other CIN criteria, which were defined as elevations of the SCr by 25% or 0.5 and 0.3 mg/dL from the baseline. The best cutoff value of lg-NT-pro-BNP for detecting CIN was 2.73 pg/mL (537 pg/mL) with 73.1% sensitivity and 70.0% specificity according to the receiver operating characteristic (ROC) analysis (C statistic = 0.754, 95% CI, 0.67-0.84, P < 0.001). In addition, NT-pro-BNP ≥537 pg/mL (2.73 pg/mL, lg-NT-pro-BNP) was associated with an increased risk of all-cause mortality and composite end points during 2.5 years of follow-up. NT-pro-BNP ≥537 pg/mL is independently associated with an increased risk of CIN with different definitions and poor clinical outcomes in patients with CKD and relative preserved LVF undergoing PCI.
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Affiliation(s)
- Yuan-hui Liu
- From the Department of Cardiology (Y-hL, YL, Y-lZ, D-qY, P-cH, N-JX, H-lL, W-G, J-yC, NT), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; and Southern Medical University (Y-hL), Guangzhou, Guangdong, China
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Shacham Y, Leshem-Rubinow E, Gal-Oz A, Topilsky Y, Steinvil A, Keren G, Roth A, Arbel Y. Association of left ventricular function and acute kidney injury among ST-elevation myocardial infarction patients treated by primary percutaneous intervention. Am J Cardiol 2015; 115:293-7. [PMID: 25476561 DOI: 10.1016/j.amjcard.2014.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 12/01/2022]
Abstract
Acute kidney injury (AKI) is a common complication among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and it is associated with poor long-term clinical outcomes. No studies have yet evaluated the association between cardiac function and the risk of AKI in this patient population. We conducted a retrospective study of consecutive 386 patients with STEMI who underwent primary PCI and had a full echocardiography study performed within 72 hours of hospital admission from June 2011 to December 2013. AKI was defined as an increase of ≥0.3 mg/dl in serum creatinine within 48 hours after admission. Thirty-four patients (9.7%) developed AKI. Echocardiography demonstrated that patients with AKI had significantly lower systolic ejection fraction (EF; 48% ± 8% vs 41% ± 10%, p <0.001), lower septal (p = 0.001) and lateral (p = 0.01) e' velocities, higher average E/e' ratio (p = 0.006), elevated systolic pulmonary artery pressure (p <0.001), and higher right atrial pressure (p = 0.001). In multivariate regression analysis, left ventricular EF emerged as an independent predictor of AKI (odds ratio 1.1, 95% confidence interval 0.86 to 0.96; p = 0.001) for every 1% reduction in EF. In conclusion, among patients with STEMI undergoing primary PCI, left ventricular EF is a strong and independent predictor of AKI.
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Affiliation(s)
- Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Eran Leshem-Rubinow
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Gal-Oz
- Department of Nephrology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Roth
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Acikel S, Akdemir R, Kilic H, Cagirci G, Dogan M, Yesilay AB, Yeter E. Diastolic dysfunction and contrast-induced nephropathy in patients undergoing coronary angiography. Herz 2014; 40 Suppl 3:254-9. [PMID: 25432103 DOI: 10.1007/s00059-014-4173-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 10/02/2014] [Accepted: 10/14/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVES It has been demonstrated that decreased left ventricular ejection fraction (LVEF) is associated with an increased risk of contrast-induced nephropathy (CIN). In this study, we aimed to assess whether there is a relationship between left ventricular (LV) diastolic dysfunction and renal function decline after coronary angiography (CAG). PATIENTS AND METHODS The study consisted of two groups: group I, patients with normal diastolic function; group II, patients with cardiac symptoms and abnormal diastolic function. Serum creatinine (Crea) and glomerular filtration rates (GFR) were measured before and after 48 h of CAG. RESULTS After the procedure, serum Crea values were higher in group II compared with group I (p = 0.051). Postprocedural 48-h GFR values determined by Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) equations were lower in group II compared with group I (p = 0.016 and p = 0.003, respectively). Delta (Δ) ΔCrea and ΔGFR determined by the Cockcroft-Gault and MDRD equations were statistically higher in group II than in group I (p = 0.005, p = 0.052, p = 0.030). The presence of higher age (p = 0.025), E/E' lateral ratio (p = 0.030), and left atrial volume index (p = 0.05) were independent predictors of worsening renal function. CONCLUSION The presence of diastolic dysfunction may play a role in determining the risk of CIN in patients with normal LVEF.
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Affiliation(s)
- S Acikel
- Department of Cardiology, Ministry of Health Dışkapı Yıldırım Beyazıt Research and Educational Hospital, 06110, Ankara, Turkey,
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Liu Y, Chen SQ, Duan CY, Tan N, Chen JY, Zhou YL, Chen PY, Huang SJ, Liu XQ. Contrast Volume-to-Creatinine Clearance Ratio Predicts the Risk of Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients With Reduced Ejection Fraction. Angiology 2014; 66:625-30. [PMID: 25158831 DOI: 10.1177/0003319714548442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We determined a relatively safe contrast media volume-to-creatinine clearance (V/CrCl) cutoff value to avoid contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients (n = 111) with reduced ejection fraction (<40%). Improved prediction of CIN in these patients would be useful. Multivariate regression models were used to evaluate whether V/CrCl is an independent risk factor for CIN. Nine (8.1%) patients developed CIN. The V/CrCl was significantly (P = .023) higher in patients with CIN than in those without. The incidence of CIN in patients with the highest tertile of V/CrCl was significantly higher than the middle and lowest tertiles (18.4% vs. 2.7% and 2.8%; P = .013). After adjusting for other potential risk factors, a V/CrCl ≥3.87 remained significantly associated with risk of CIN. A V/CrCl <3.87 might be valuable in predicting the risk of CIN in patients with reduced ejection fraction undergoing PCI.
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Affiliation(s)
- Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China These authors contributed equally to this work
| | - Shi-Qun Chen
- Department of Biostatistics, Guangdong Society of Interventional Cardiology, Guangzhou, China These authors contributed equally to this work
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China These authors contributed equally to this work
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-Ling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ping-Yan Chen
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Shui-Jin Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Qi Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Au TH, Bruckner A, Mohiuddin SM, Hilleman DE. The Prevention of Contrast-Induced Nephropathy. Ann Pharmacother 2014; 48:1332-42. [DOI: 10.1177/1060028014541996] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: Contrast-induced nephropathy (CIN) is a complication which may develop after exposure to iodinated contrast media. The resulting acute kidney injury (AKI) is associated with an increase in both short- and long-term morbidity and mortality, increased hospital length of stay, and greater health care costs. The pathophysiological mechanism associated with the development of CIN remains unknown. This narrative review summarizes the pathophysiology, risk factors, and current evidence for the prevention of CIN. Data Sources: A MEDLINE literature search (2004-May 2014) was performed using search terms contrast-induced nephropathy and prevention. Additional references were identified from literature citations, review articles, and meta-analyses. Study Selection and Data Extraction: Abstracts of English-language human clinical trials that examined therapies for the prevention of CIN were evaluated. Studies that did not investigate a preventative intervention for CIN were excluded. Emphasis was placed on recent publications. Data Synthesis: A multitude of therapies focused on the prevention of CIN have been investigated. Unfortunately, many of these studies have produced negative and/or inconsistent results. There is a paucity of adequately designed clinical studies evaluating strategies for the prevention of CIN. However, the best data supports use of preprocedural hydration with isotonic solution as the standard of care for prophylaxis. Conclusion: Given the poor prognosis associated with CIN, there is need for improved methods to prevent it. At present, the best tools to protect patients from unnecessary risk for CIN are careful assessment of renal function, judicious use of procedures that utilize contrast media, and adequate hydration with isotonic solution.
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Affiliation(s)
| | - Anne Bruckner
- Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | | | - Daniel E. Hilleman
- Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
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Rodriguez KT, O'Brien MA, Hartman SK, Mulherin AC, McReynolds CJ, McMichael M, Rapoport G, O'Brien RT. Microdose computed tomographic cardiac angiography in normal cats. J Vet Cardiol 2014; 16:19-25. [DOI: 10.1016/j.jvc.2013.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 12/10/2013] [Accepted: 12/11/2013] [Indexed: 12/01/2022]
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Li WH, Li DY, Qian WH, Liu JL, Xu TD, Zhu H, He HY. Prevention of contrast-induced nephropathy with prostaglandin E1 in high-risk patients undergoing percutaneous coronary intervention. Int Urol Nephrol 2014; 46:781-6. [PMID: 24570327 DOI: 10.1007/s11255-014-0674-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 02/13/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE Contrast-induced nephropathy (CIN) is an important complication in the use of iodinated contrast media. The present study aimed to assess the safety and efficacy of prostaglandin E1 (PGE1) in prevention of CIN in patients with high-risk factors undergoing percutaneous coronary intervention (PCI). METHODS The study group consisted of 163 patients who had undergone a coronary intervention procedure between January 1, 2012 and October 31, 2012. Study participants were randomly assigned to either the PGE1 group (82 patients) or the control group (81 patients). Patients in the PGE1 group received PGE1 intravenous infusion of 20 ng/kg/min for 6 h before and after the administration of contrast media. The control group received 0.9 % sodium chloride solution for routine hydration only. A nonionic, low-osmolality contrast agent was used in our laboratory at this time. Serum creatinine (Scr) values and estimated glomerular filtration rate were measured before and within 48 h of the administration of contrast agents. CIN was defined as an increase of ≥0.5 mg/dL or ≥ a 25 % increase in Scr concentrations over baseline within 48 h of angiography. RESULTS The amount of contrast agent administered was similar for the PGE1 and control groups (156 ± 63 vs. 161 ± 68 mL, P > 0.05). The incidence of CIN was lower in the PGE1 group than in the control group (3.7 vs. 11.1 %, P < 0.05). No serious adverse effects were observed. CONCLUSIONS In patients with high-risk factors undergoing PCI, the use of PGE1 for prevention of CIN is safe and efficacious.
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Affiliation(s)
- Wen-Hua Li
- Department of Cardiology, Affiliated Hospital of XuZhou Medical College, No. 99 Huaihai West Road, Xuzhou, 221002, China,
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Liu YH, Liu Y, Tan N, Chen JY, Chen J, Chen SH, He YT, Ran P, Ye P, Li Y. Predictive value of GRACE risk scores for contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction before undergoing primary percutaneous coronary intervention. Int Urol Nephrol 2013; 46:417-26. [DOI: 10.1007/s11255-013-0598-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/30/2013] [Indexed: 01/03/2023]
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Koo HM, Doh FM, Ko KI, Kim CH, Lee MJ, Oh HJ, Han SH, Kim BS, Yoo TH, Kang SW, Choi KH. Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: a retrospective cohort study. BMC Nephrol 2013; 14:146. [PMID: 23849485 PMCID: PMC3717078 DOI: 10.1186/1471-2369-14-146] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 07/08/2013] [Indexed: 01/20/2023] Open
Abstract
Background Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN. Methods We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% in serum creatinine level during the 72 hours following PTCA. Results CIN occurred in 64 patients (8.7%). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E’ in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E’ values of 8 and 15, CIN occurred in 42 (21.6%) patients in the highest tertile compared with 20 (4.0%) in the middle and 2 (4.3%) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E’ > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E’ was 0.751 (95% CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001). Conclusions This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.
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Affiliation(s)
- Hyang Mo Koo
- Department of Internal Medicine, College of Medicine, Yonsei University, 134 Shinchon-dong, Seodaemun-gu, Seoul, Korea
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Weisbord SD, Gallagher M, Kaufman J, Cass A, Parikh CR, Chertow GM, Shunk KA, McCullough PA, Fine MJ, Mor MK, Lew RA, Huang GD, Conner TA, Brophy MT, Lee J, Soliva S, Palevsky PM. Prevention of contrast-induced AKI: a review of published trials and the design of the prevention of serious adverse events following angiography (PRESERVE) trial. Clin J Am Soc Nephrol 2013; 8:1618-31. [PMID: 23660180 DOI: 10.2215/cjn.11161012] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Contrast-induced AKI (CI-AKI) is a common condition associated with serious, adverse outcomes. CI-AKI may be preventable because its risk factors are well characterized and the timing of renal insult is commonly known in advance. Intravenous (IV) fluids and N-acetylcysteine (NAC) are two of the most widely studied preventive measures for CI-AKI. Despite a multitude of clinical trials and meta-analyses, the most effective type of IV fluid (sodium bicarbonate versus sodium chloride) and the benefit of NAC remain unclear. Careful review of published trials of these interventions reveals design limitations that contributed to their inconclusive findings. Such design limitations include the enrollment of small numbers of patients, increasing the risk for type I and type II statistical errors; the use of surrogate primary endpoints defined by small increments in serum creatinine, which are associated with, but not necessarily causally related to serious, adverse, patient-centered outcomes; and the inclusion of low-risk patients with intact baseline kidney function, yielding low event rates and reduced generalizability to a higher-risk population. The Prevention of Serious Adverse Events following Angiography (PRESERVE) trial is a randomized, double-blind, multicenter trial that will enroll 8680 high-risk patients undergoing coronary or noncoronary angiography to compare the effectiveness of IV isotonic sodium bicarbonate versus IV isotonic sodium chloride and oral NAC versus oral placebo for the prevention of serious, adverse outcomes associated with CI-AKI. This article discusses key methodological issues of past trials investigating IV fluids and NAC and how they informed the design of the PRESERVE trial.
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Affiliation(s)
- Steven D Weisbord
- Renal Section, VeteransAffairs PittsburghHealthcare System, Pittsburgh, PA 15240, USA.
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Li WH, Li DY, Han F, Xu TD, Zhang YB, Zhu H. Impact of anemia on contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary interventions. Int Urol Nephrol 2012; 45:1065-70. [PMID: 23225080 PMCID: PMC3732774 DOI: 10.1007/s11255-012-0340-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 11/16/2012] [Indexed: 12/26/2022]
Abstract
Background The aim of the present study was to assess the influence of anemia on the risk of developing contrast-induced nephropathy after percutaneous coronary angioplasty. Methods Serum creatinine values were measured before and within 48 h after the administration of contrast agents. Contrast-induced nephropathy (CIN) was defined as an increase of ≥0.5 mg/dl or ≥25 % in serum creatinine concentration over baseline within 48 h after administration. Anemia was defined as hemoglobin <120 g/l in women and <130 g/l in men. Results Among the 1,026 patients studied, 32 (3.1 %) developed CIN after procedure. CIN occurred in 6.3 % of the anemic patients and in 2.2 % of the non-anemic patients (P < 0.01). The incidence of CIN increased with decreasing of baseline estimated glomerular filtration rate (eGFR) in both the anemia and non-anemia groups. In patients with baseline eGFR <30 ml/min, a high proportion of both anemic and non-anemic patients experienced CIN (24.6 vs. 17.5 %). When baseline eGFR was 30–59 ml/min, the incidence of CIN in anemic patients was twofold higher than in non-anemic patients (7.9 vs. 3.8 %; P < 0.05). Multivariate logistic regression analysis found that baseline eGFR and baseline hemoglobin were independent predictors of CIN. Conclusion Anemia is associated with a higher incidence of CIN in patients with moderate renal dysfunction. Patients with both preexisting renal insufficiency and anemia are at high risk of CIN. Baseline eGFR and baseline hemoglobin are independent predictors of CIN.
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Affiliation(s)
- Wen-hua Li
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical College, No. 99 Huihai west Road, Xuzhou, 221002, China.
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Balemans CEA, Reichert LJM, van Schelven BIH, van den Brand JAJG, Wetzels JFM. Epidemiology of contrast material-induced nephropathy in the era of hydration. Radiology 2012; 263:706-13. [PMID: 22535561 DOI: 10.1148/radiol.12111667] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the incidence of contrast material-induced nephropathy (CIN) in patients with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m(2) who received intravenous contrast media and underwent treatment in accordance with current guidelines and to determine risk factors associated with CIN. MATERIALS AND METHODS The research ethics committee waived the requirement for informed consent for this prospective cohort study. All nonhospitalized patients with an eGFR of less than 60 mL/min/1.73 m(2) were seen at a special outpatient clinic. Patients were stratified for the risk of CIN. They were classified as having high or low risk for CIN on the basis of absolute glomerular filtration rate (Modification of Diet in Renal Disease formula result multiplied by body surface area divided by 1.73 m(2)) and the presence of risk factors. Patients at high risk were hydrated with 1000 mL of isotonic saline before and after contrast material exposure. Serum creatinine level was measured 3-5 days later, and CIN was defined as an increase of 25% of more from the baseline level. Risk factors were recorded and compared between patients with CIN and those without CIN by using forward stepwise multiple logistic regression analysis. RESULTS A total of 944 procedures in 747 patients were evaluated. Mean age was 71.3 years ± 10 (standard deviation), and 42.9% of patients were female. In 511 procedures (54.1%), patients were hydrated. CIN developed after 23 procedures (2.4%). No patient needed hemodialysis treatment. Heart failure (odds ratio, 3.0), body mass index (BMI) (odds ratio, 0.9), and repeated contrast material administration (odds ratio, 2.8) were found to be independent predictors of CIN. CONCLUSION Heart failure, low BMI, and repeated contrast material administration were identified as risk factors for CIN under the current treatment strategy. The low incidence of CIN supports the use of hydration as a preventive measure in patients at high risk for CIN.
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Affiliation(s)
- Corinne E A Balemans
- Department of Nephrology 464, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Tester GA, Noheria A, Carrico HL, Mears JA, Cha YM, Powell BD, Friedman PA, Rea RF, Hayes DL, Asirvatham SJ. Impact of radiocontrast use during left ventricular pacemaker lead implantation for cardiac resynchronization therapy. Europace 2012; 14:243-248. [DOI: 10.1093/europace/eur282] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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The contrast medium volume to estimated glomerular filtration rate ratio as a predictor of contrast-induced nephropathy after primary percutaneous coronary intervention. Int Urol Nephrol 2011; 44:221-9. [PMID: 21336957 DOI: 10.1007/s11255-011-9910-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 02/04/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a serious complication in percutaneous coronary intervention (PCI) patients, which may be related to the contrast dose used during cardiac catheterization. METHODS We prospectively investigated 277 consecutive consenting patients with acute ST-segment elevation myocardial infarction (STEMI) who were given primary PCI, and we calculated their ratio of volume of contrast media to estimated glomerular filtration rate (V/eGFR). Receiver-operator characteristic methods were used to identify the optimal sensitivity for the observed range of V/eGFR for CIN (i.e., within 48-72 h). The predictive value of V/eGFR for the risk of CIN was assessed using multivariable logistic regression. RESULTS Twenty-five (9%) patients developed CIN. The baseline mean and median V/eGFR values were significantly greater among patients with CIN (mean 3.22 ± 1.53, median 2.97, and interquartile range 1.90-4.17) than among those without CIN (mean 1.80 ± 1.00, median 1.52, and interquartile range 1.12-2.21, P < 0.001). The receiver-operator characteristic curve analysis indicated that a V/eGFR ratio of 2.39 was a fair discriminator for CIN (C statistic 0.81). After adjusting for other known predictors of CIN, a V/eGFR ratio ≥ 2.39 remained significantly associated with CIN (odds ratio 4.24, 95% confidence interval 1.23-14.66, P < 0.05). CONCLUSION A V/eGFR ratio ≥ 2.39 was a significant and independent predictor of CIN after primary PCI in patients with STEMI.
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