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Goyal A, Sulaiman SA, Pancholi V, Fatima L, Yakkali S, Doshi A, Hurjkaliani S, Jain H, Khan R, Sohail AH. Exploring Acute Kidney Injury Following Aortic Dissection: A Comprehensive Review of Machine Learning Models for Predicting Risk, Management Strategies, Complications, and Racial and Gender Disparities. Cardiol Rev 2024:00045415-990000000-00275. [PMID: 38785437 DOI: 10.1097/crd.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Both types of aortic dissection (AD), Stanford type A and type B, can result in complications such as acute kidney injury (AKI) and aortic rupture. Renal complications in AD arise from compromised renal perfusion affecting the renal arteries. Understanding the intricate connection between AD and AKI is crucial for navigating the complexities of tailored treatment and formulating specific management plans. Concerning machine learning models, in patients with type A aortic dissection, factors such as decreased platelet count on admission, increased D-dimer level, longer cardiopulmonary bypass duration, elevated white blood cell levels, the need for blood transfusion, longer aortic clamp time, extended surgery duration, advanced age, and an elevated body mass index were positively associated with the development of AKI. For the risk of AKI after type B aortic dissection, elevated Nt-pro brain natriuretic peptide, prolonged activated partial thromboplastin time, elevated admission systolic blood pressure, and a higher contrast agent requirement during operative repair were found to predict the risk. Male gender was associated with a higher risk of AKI, and nonwhite race was linked to a higher risk of AKI, a greater likelihood of requiring more urgent procedures, and lower levels of insurance coverage. The treatment of AKI following AD requires a multifaceted approach. Identifying and addressing the underlying cause, such as low blood pressure, renal artery involvement, or medication-induced injury, is crucial for effective management and preventing further kidney damage. Maintaining proper fluid balance is essential for improving renal perfusion, but careful monitoring is necessary to avoid complications. The evolving landscape of research, particularly in biomarkers and AI programs, reveals a promising role in predicting the risk for and managing AKI post-AD.
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Affiliation(s)
- Aman Goyal
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Samia Aziz Sulaiman
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Vidhi Pancholi
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Laveeza Fatima
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Shreyas Yakkali
- Department of Internal Medicine, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Apoorva Doshi
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sonia Hurjkaliani
- Department of Internal Medicine, Dow University of Health Science, Karachi, Pakistan
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences-Jodhpur, Rajasthan, India
| | - Rozi Khan
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM
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Garcia-Guimaraes M, Masotti M, Sanz-Ruiz R, Macaya F, Roura G, Nogales JM, Tizón-Marcos H, Velázquez-Martin M, Veiga G, Flores-Ríos X, Abdul-Jawad Altisent O, Jimenez-Kockar M, Camacho-Freire S, Moreu J, Ojeda S, Santos-Martinez S, Sanz-Garcia A, Del Val D, Bastante T, Alfonso F. Clinical outcomes in spontaneous coronary artery dissection. Heart 2022; 108:1530-1538. [PMID: 35410894 DOI: 10.1136/heartjnl-2022-320830] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/22/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome. Our aim was to assess adverse events at follow-up from a nationwide prospective cohort. METHODS The Spanish Registry on SCAD (SR-SCAD) included patients from 34 hospitals. All coronary angiograms were analysed by two experts. Those cases with doubts regarding the diagnosis of SCAD were excluded. The angiographic SCAD classification by Saw et al was followed. Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularisation, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee. RESULTS After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47-60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural haematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17-38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularisations (6.2%). Previous history of hypothyroidism (HR 3.79; p<0.001), proximal vessel involvement (HR 2.69; p=0.009), type 2 IMH (HR 2.12; p=0.037) and dual antiplatelet therapy (DAPT) at discharge (HR 2.18; p=0.042) were independent predictors of MACCE. CONCLUSIONS In this large prospective cohort of patients with SCAD, prognosis was overall favourable, with events mainly driven by reinfarctions or unplanned revascularisations. History of hypothyroidism, proximal vessel involvement, type 2 IMH and DAPT at discharge were associated with MACCE. TRIAL REGISTRATION NUMBER NCT03607981.
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Affiliation(s)
- Marcos Garcia-Guimaraes
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Monica Masotti
- Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Gerard Roura
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Maite Velázquez-Martin
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Gabriela Veiga
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Xacobe Flores-Ríos
- Department of Cardiology, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Omar Abdul-Jawad Altisent
- Department of Cardiology, Hospital Clínic, Barcelona, Spain.,Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Jose Moreu
- Department of Cardiology, Hospital General Universitario de Toledo, Toledo, Spain
| | - Soledad Ojeda
- Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.,Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Sandra Santos-Martinez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ancor Sanz-Garcia
- Data Analysis Unit, Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain .,Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
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Mukaiyama Y, Okada A, Kawakatsu Y, Akuzawa S, Suzuki K, Ishigami N, Yamamoto T. Complete post-operative resolution of "temporary" end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study. BMC Nephrol 2019; 20:368. [PMID: 31615429 PMCID: PMC6794814 DOI: 10.1186/s12882-019-1559-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI), which may progress to end-stage kidney disease (ESKD), is a potential complication of aortic dissection. Notably, in all reported ESKD cases secondary to aortic dissection, imaging evidence of static obstruction of the renal arteries always shows either renal artery stenosis or extension of the dissection into the renal arteries. CASE PRESENTATION We present the case of a 58-year-old man with hypertension who was diagnosed with a Stanford type B aortic dissection and treated with medications alone because there were no obvious findings indicative of dissection involving the renal arteries. He had AKI, which unexpectedly progressed to ESKD, without any radiological evidence of direct involvement of the renal arteries. Thus, we failed to attribute the ESKD to the dissection and hesitated to perform any surgical intervention. Nevertheless, the patient's hormonal levels, fractional excretion values, ankle brachial indices, and Doppler resistive indices seemed to indirectly suggest kidney malperfusion and implied renal artery hypo-perfusion. However, abdominal computed tomography imaging only revealed progressive thrombotic obstruction of the false lumen and compression of the true lumen in the descending thoracic aorta, despite the absence of anatomical blockage of renal artery perfusion. Later, signs of peripheral malperfusion, such as intermittent claudication, necessitated surgical intervention; a graft replacement of the aorta was performed. Post-operatively, the patient completely recovered after 3 months of haemodialysis, and the markers that had pre-operatively suggested decreased renal bloodstream normalised with recovery of kidney function. CONCLUSIONS To the best of our knowledge, this is the first report of severe AKI, secondary to aortic dissection, without direct renal artery obstruction, which progressed to "temporary" ESKD and was resolved following surgery. This case suggests that only coarctation above the renal artery branches following an aortic dissection can progress AKI to ESKD, despite the absence of radiological evidence confirming an obvious anatomical blockage. Further, indirect markers suggestive of decreased renal blood flow, such as ankle brachial indices, renal artery resistive indices, urinary excretion fractions, and hormonal changes, are useful for evaluating concomitant AKI and may indicate the need for surgical intervention after a Stanford type B aortic dissection.
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Affiliation(s)
- Yoshihiro Mukaiyama
- Department of Urology, Takashimadaira Chuo General Hospital, 1-73-1 Takashimadaira, Itabashi, Tokyo, 175-0082, Japan
| | - Akira Okada
- Divison of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yutaro Kawakatsu
- Department of Nephrology, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Satoshi Akuzawa
- Department of Cardiovascular Surgery, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Kazuchika Suzuki
- Department of Cardiovascular Surgery, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Naoyuki Ishigami
- Department of Cardiovascular Surgery, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Tatsuo Yamamoto
- Department of Nephrology, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda, Shizuoka, 426-8677, Japan
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Volckaert V, Vandermeulen E, Dobbeleir A, Duchateau L, Saunders JH, Peremans K. Effect of thyroid volume on radioiodine therapy outcome in hyperthyroid cats. J Feline Med Surg 2016; 18:144-9. [PMID: 25769623 PMCID: PMC11149016 DOI: 10.1177/1098612x15576587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radioiodine therapy is commonly used in hyperthyroid cats and has a high success rate, ranging from 85-95%. As in humans, thyroid volume has been reported to influence radioiodine therapy outcome in hyperthyroid cats. The purpose of this study was to relate total thyroid volume, calculated by a newly constructed formula for feline patients (0.438 × length × width²), to the outcome of radioiodine therapy. To search for a correlation between total thyroid volume and therapy outcome, 167 hyperthyroid cats were included. Patients were categorised according to the administered radioiodine dose and therapy outcome. Our analysis did not show a significant relationship between an increasing total thyroid volume and the odds for a final low total thyroxine concentration (TT4; P = 0.3930) or a final hyperthyroid outcome (P = 0.0901). A significant relationship was found for an increase in the odds for a final low TT4 outcome with an increase in the number of foci detected on the pertechnetate thyroid scan (P = 0.0238). This was not true for a final hyperthyroid outcome (P = 0.7435). The number of detected foci was also significantly associated with the total thyroid volume (P = 0.0006). Findings indicated that the presence of multiple affected foci influences therapy outcome towards a low TT4 outcome. Bilateral hyperthyroidism and its potential effect on a final low TT4 outcome should therefore be addressed when informing owners of the possible outcomes of radioiodine therapy for their cat.
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Affiliation(s)
- Veerle Volckaert
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eva Vandermeulen
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - André Dobbeleir
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luc Duchateau
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Jimmy H Saunders
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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