Early Renal-Protective Effects of Remote Ischemic Preconditioning in Elderly Patients with Non-ST-Elevation Myocardial Infarction (NSTEMI)

Resistive index as predictor of acute kidney injury in patients with non-ST-segment elevation myocardial infarction

BACKGROUND

Acute kidney injury (AKI) is common in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Early detection of AKI is likely to speed diagnosis and implementation of measures to preserve renal function. To evaluate if renal Doppler resistive index (RI) would predict AKI in patients with NSTEMI on presentation in the emergency department.

METHODS

Patients with NSTEMI at the emergency department were included. The renal Doppler RI was measured. Baseline demographic data and clinical characteristics of patients at admittance were recorded. Based on discharge diagnosis, the patients were divided into AKI group and no-AKI group. Multiple logistic regression analysis was performed to determine predictor variables significantly associated with AKI.

RESULTS

A total of 293 patients were included in the analysis; 44 (15.0%) developed AKI without need for dialysis. There were statistical differences in the age, incidence of diabetes mellitus and cerebrovascular disease, beta-receptor blockers, serum creatinine and renal index between the two groups. Using multivariate logistic regression analysis, age [OR 1.87; 95% confidence interval (CI) 1.595-2.585; p = 0.027], diabetes mellitus (OR 2.007, 95% CI: 1.489-2.793; p = 0.014), serum creatinine (OR 1.817, 95% CI: 1.568-2.319; p = 0.013), and RI (OR 2.168, 95% CI: 1.994-4.019; p = 0.003) predicted AKI in patients with NSTEMI. According to receiver operating characteristic (ROC) analysis, RI showed a significantly increased area under the curve (AUC) compared to serum creatitine (AUC: 0.891 vs 0.679; p < 0.001).

CONCLUSIONS

Renal Doppler RI may be a useful predictor of AKI in patients with NSTEMI in the emergency department.

Transplantation of Umbilical Cord-Derived Mesenchymal Stem Cells Overexpressing Lipocalin 2 Ameliorates Ischemia-Induced Injury and Reduces Apoptotic Death in a Rat Acute Myocardial Infarction Model

Myocardial infarction (MI) is a leading cause of death worldwide and requires development of efficient therapeutic strategies . Mesenchymal stem cells (MSCs) -based therapy of MI has been promising but inefficient due to undesirable microenvironment of the infarct tissue. Hence, the current study was conducted to fortify MSCs against the unfavorable microenvironment of infarct tissue via overexpression of Lipocalin 2 (Lcn2) as a cytoprotective factor. The engineered cells (Lcn2-MSCs) were transplanted to infarcted heart of a rat model of MI. According to our findings, Lcn2 overexpression resulted in increased MSCs survival in the MI tissue (p < 0.05) compared to non-engineered cells. Furthermore, the infusion of Lcn2-MSCs mitigated Left ventricle (LV) remodeling, decreased fibrosis (p < 0.0001), and reduced apoptotic death of the LVs' cells (p < 0.0001) compared to the control. Our findings suggest a potential novel therapeutic strategy for MI, however, further investigations such as safety and efficacy assessments in large animals followed by clinical trials are required.