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Özdemir E, Akçay FA, Esen S, Emren SV, Karaca M, Nazlı C, Kırış T. Predictive Value of the Modified Mehran Score for Contrast-Induced Nephropathy After Transcatheter Aortic Valve Implantation. Angiology 2024; 75:267-273. [PMID: 36628494 DOI: 10.1177/00033197231151269] [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] [Indexed: 01/12/2023]
Abstract
Considering the increasing use of the transcatheter aortic valve implantation (TAVI) procedure, the relationship of contrast-induced nephropathy (CIN) with post-TAVI mortality has become important. The Mehran score was developed to detect the risk of CIN development after cardiac intervention. We aimed to compare the role of the modified Mehran score, which can be calculated pre-procedure, in predicting CIN development and compare it with the original Mehran score. We retrospectively collected data from TAVI procedures at our institution between December 2016 and June 2021; of 171 patients, 44 (25.7%) had CIN. We found no association between contrast media volume and CIN (387 ± 120 vs 418 ± 139 mL, P = .303). High and very high modified Mehran score and preoperative C-reactive protein (CRP) level were independent risk factors for CIN development after TAVI procedure. The area under curve (AUC) was .686 with 95% CI: .591-.780 and P < .001, and also, with a cut-off point of >7.5 points, there was 79.5% sensitivity and 63.0% specificity; otherwise, with a cut-off point of >9.5 points, there was 54.5% sensitivity and 71.7% specificity, for the modified Mehran score. The modified Mehran score comes into prominence compared with the original Mehran score since it can be calculated pre-procedure.
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Affiliation(s)
- Emre Özdemir
- Deparment of Cardiology, Katip Çelebi University, Faculty of Medicine, Atatürk Training and Reseach Hospital, Izmir, Turkiye
| | - Filiz Akyıldız Akçay
- Deparment of Cardiology, Katip Çelebi University, Faculty of Medicine, Atatürk Training and Reseach Hospital, Izmir, Turkiye
| | - Saban Esen
- Deparment of Cardiology, Katip Çelebi University, Faculty of Medicine, Atatürk Training and Reseach Hospital, Izmir, Turkiye
| | - Sadık Volkan Emren
- Deparment of Cardiology, Katip Çelebi University, Faculty of Medicine, Atatürk Training and Reseach Hospital, Izmir, Turkiye
| | - Mustafa Karaca
- Deparment of Cardiology, Katip Çelebi University, Faculty of Medicine, Atatürk Training and Reseach Hospital, Izmir, Turkiye
| | - Cem Nazlı
- Deparment of Cardiology, Katip Çelebi University, Faculty of Medicine, Atatürk Training and Reseach Hospital, Izmir, Turkiye
| | - Tuncay Kırış
- Deparment of Cardiology, Katip Çelebi University, Faculty of Medicine, Atatürk Training and Reseach Hospital, Izmir, Turkiye
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Iacovelli F, Pignatelli A, Cafaro A, Stabile E, Salemme L, Cioppa A, Pucciarelli A, Spione F, Loizzi F, De Cillis E, Pestrichella V, Bortone AS, Tesorio T, Contegiacomo G. Impact of contrast medium osmolality on the risk of acute kidney injury after transcatheter aortic valve implantation: insights from the Magna Graecia TAVI registry. Int J Cardiol 2020; 329:56-62. [PMID: 33359334 DOI: 10.1016/j.ijcard.2020.12.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/25/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is frequent and associated with adverse outcomes and mortality; to date, in such setting of patients there is no consistent evidence that either low-osmolar contrast media (LOCM) or iso-osmolar contrast medium (IOCM) are superior to the other in terms of renal safety. METHODS 697 consecutive patients not in hemodialysis treatment who underwent TAVI (327 males, mean age 81.01 ± 5.75 years, mean european system for cardiac operative risk evaluation II 6.17 ± 0.23%) were enrolled. According to osmolality of the different iodinated CM, the population was divided in 2 groups: IOCM (n = 370) and LOCM group (n = 327). Preoperatively, 40.54% of patients in IOCM vs 39.14% in LOCM group (p = 0.765) suffered from chronic kidney disease (CKD). RESULTS The incidence of AKI was significantly lower with IOCM (9.73%) than with LOCM (15.90%; p = 0.02), and such significant difference (p < 0.001) in postprocedural change of renal function parameters persisted at discharge too. The incidence of AKI was also significantly lower with IOCM in younger patients, without diabetes, anemia, coronary artery disease history, CKD, chronic or persistent atrial fibrillation, left ventricular ejection fraction ≤35%, and in patients with low operative mortality risk scores, receiving lower amounts of dye (p < 0.05 for all). Importantly, multivariate analysis identified LOCM administration as an independent risk factor for both AKI (p = 0.006) and 1-year mortality (p = 0.001). CONCLUSIONS The use of IOCM have a favorable impact on renal function with respect to LOCM, but it should be considered especially for TAVI patients at lower AKI risk.
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Affiliation(s)
- Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy.
| | - Antonio Pignatelli
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Bari, Italy
| | | | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Salemme
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Angelo Cioppa
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Armando Pucciarelli
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Francesco Loizzi
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Gaetano Contegiacomo
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Bari, Italy
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Adamo M, Alos B, Metra M, Lefèvre T, Swaans MJ, Gheorghe L, Tschöpe C, Krackhardt F, Alfieri O, Bouleti C. Patient with heart failure: importance to treat valvular diseases. Eur Heart J Suppl 2020; 22:P38-P41. [PMID: 33390869 PMCID: PMC7757709 DOI: 10.1093/eurheartj/suaa184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COVID-19 pandemic is causing an unprecedented burden on healthcare resources and this includes treatment of heart failure and valvular heart diseases (VHD). Percutaneous procedures have broadened the number of patients with VHD who could be treated. However, COVID-19 pandemic has challenged their implementation. The risk of in-hospital infection, resources reallocation, reduced access to hospital caused a substantial delay of VHD treatment with an increased risk of clinical worsening and mortality. Now, the pandemic is not ended and subsequent waves are likely. Reorganization of our healthcare resources is needed, including a proper algorithm for patients’ prioritization, based on the severity of their valve disease, their life expectancy, complexity of the intervention, and the resources available. A wider use of telemedicine for patients’ selection and follow-up and any measurement that can shorten the duration of the hospital stay must be adopted. Patients’ and healthcare staff screening for COVID-19 and all needed procedures to prevent infection will continue to be mandatory. Percutaneous procedures, compared to surgery, are associated with a lower risk of infection and a lower need for in-hospital resources, including a shorter duration of hospital stay. This may favour their adoption when the risk of viral infection is high.
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Affiliation(s)
- Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Benjamin Alos
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Thierry Lefèvre
- Department of Cardiology, Institut cardiovasculaire Paris Sud, Hopital privé Jacques Cartier, Ramsay Générale de santé, Massy, France
| | - Martins J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Livia Gheorghe
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Carsten Tschöpe
- Department of Cardiology, Charite, Campus Virchow, Berlin, Germany.,Department of Cardiology, Berlin Center for Regenerative Therapies/Berlin Institute of Health (BCRT/BIH), Charite, Berlin, Germany
| | | | - Ottavio Alfieri
- Department of Cardiology, S. Raffaele University Hospital Milano, Milan, Italy
| | - Claire Bouleti
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France.,Department of Cardiology, Clinical Investigation Center (CIC) INSERM 1402, University of Poitiers, Poitiers, France
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