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Diastolic dysfunction predicts the risk of contrast-induced nephropathy and outcome post-emergency percutaneous coronary intervention in AMI patients with preserved ejection fraction

Heart and Vessels volume 33, pages 1149–1158 (2018)Cite this article

Abstract

Patients with acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (LVEF) are at high risk of contrast-induced nephropathy (CIN). However, the risk factors of CIN in AMI patients with preserved LVEF remain largely unknown now. The present study explored the relationship between LV diastolic function and CIN in this patient cohort. The present prospective cohort study enrolled 379 AMI patients with preserved LVEF (≥ 50%) who underwent emergency percutaneous coronary interventions (PCI). Transthoracic echocardiography was performed before PCI using a portable echocardiography system. Diastolic function was graded as normal, indeterminate and diastolic dysfunction according to the current recommendation of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. A total of 88 patients (23.2%) developed CIN. Multivariate logistic regression analysis showed that both diastolic dysfunction (DD) and the mitral E velocity to mitral annular tissue Doppler E′ velocity ratio (E/E′) were independent predictors of CIN (P < 0.001). Other independent risk factors of CIN included increased Mehran score, ST-segment-elevation myocardial infarction, higher HbA1c and left anterior descending lesion, as well as the use of diuretics. Multivariate Cox regression analysis found that CIN, DD, higher N-terminal pro-B-type natriuretic peptide and HbA1c were independent predictors of MACE 2 years after AMI. Diastolic dysfunction determined before emergency PCI is linked with increased risk of CIN in AMI patients with preserved LVEF. CIN and diastolic dysfunction are independent predictors of MACE at 2 years in this patient cohort.

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References

  1. McCullough PA (2008) Contrast-induced acute kidney injury. J Am Coll Cardiol 51:1419–1428

    Article  PubMed  Google Scholar 

  2. Nash K, Hafeez A, Hou S (2002) Hospital-acquired renal insufficiency. Am J Kidney Dis 39:930–936

    Article  PubMed  Google Scholar 

  3. Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ, Singh M, Bell MR, Barsness GW, Mathew V, Garratt KN, Holmes DR Jr (2002) Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 105:2259–2264

    Article  PubMed  Google Scholar 

  4. Rundback JH, Nahl D, Yoo V (2011) Contrast-induced nephropathy. J Vasc Surg 54:575–579

    Article  PubMed  Google Scholar 

  5. Chong E, Poh KK, Liang S, Soon CY, Tan HC (2010) Comparison of risks and clinical predictors of contrast-induced nephropathy in patients undergoing emergency versus nonemergency percutaneous coronary interventions. J Interv Cardiol 23:451–459

    Article  PubMed  Google Scholar 

  6. Abe D, Sato A, Hoshi T, Kakefuda Y, Watabe H, Ojima E, Hiraya D, Harunari T, Takeyasu N, Aonuma K (2014) Clinical predictors of contrast-induced acute kidney injury in patients undergoing emergency versus elective percutaneous coronary intervention. Circ J 78:85–91

    Article  PubMed  CAS  Google Scholar 

  7. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G (2004) A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 44:1393–1399

    PubMed  Google Scholar 

  8. Ozkok S, Ozkok A (2017) Contrast-induced acute kidney injury: a review of practical points. World J Nephrol 6:86–99

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tung YC, Chang CH, Chen YC, Chu PH (2015) Combined biomarker analysis for risk of acute kidney injury in patients with ST-segment elevation myocardial infarction. PLoS One 10:e0125282

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Liu Y, Tan N, Zhou YL, Chen YY, Chen JY, Chen J, Luo JF (2012) High-sensitivity C-reactive protein predicts contrast-induced nephropathy after primary percutaneous coronary intervention. J Nephrol 25:332–340

    Article  PubMed  CAS  Google Scholar 

  11. Pyxaras SA, Sinagra G, Mangiacapra F, Perkan A, Di Serafino L, Vitrella G, Rakar S, De Vroey F, Santangelo S, Salvi A, Toth G, Bartunek J, De Bruyne B, Wijns W, Barbato E (2013) Contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention without acute left ventricular ejection fraction impairment. Am J Cardiol 111:684–688

    Article  PubMed  Google Scholar 

  12. Victor BM, Barron JT (2010) Diastolic heart failure versus diastolic dysfunction: difference in renal function. Clin Cardiol 33:770–774

    Article  PubMed  Google Scholar 

  13. Verma A, Anavekar NS, Meris A, Thune JJ, Arnold JM, Ghali JK, Velazquez EJ, McMurray JJ, Pfeffer MA, Solomon SD (2007) The relationship between renal function and cardiac structure, function, and prognosis after myocardial infarction: the VALIANT Echo Study. J Am Coll Cardiol 50:1238–1245

    Article  PubMed  Google Scholar 

  14. Thygesen K, Alpert JS, White HD, Joint ESC/ACCF, AHA, WHF Task Force for the Redefinition of Myocardial Infarction (2007) Universal definition of myocardial infarction. J Am Coll Cardiol 50:2173–2195

    Article  PubMed  Google Scholar 

  15. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation: Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470

    Article  PubMed  CAS  Google Scholar 

  16. Thomsen HS (2003) Guidelines for contrast media from the European Society of Uro-genital Radiology. Am J Roentgenol 181:1463–1471

    Article  Google Scholar 

  17. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39.e14

    Article  PubMed  Google Scholar 

  18. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277–314

    Article  PubMed  Google Scholar 

  19. Park JJ, Chae IH, Choi DJ, Kang SM, Yoo BS, Hwang JJ, Lin SJ, Wen MS, Zhang J, Ge J, COAST Investigators (2016) Renal function, serum sodium level, and outcomes in hospitalized systolic heart failure patients: an analysis of the COAST study. Medicine (Baltimore) 95:e3898

    Article  CAS  Google Scholar 

  20. Sharma K, Hill T, Grams M, Daya NR, Hays AG, Fine D, Thiemann DR, Weiss RG, Tedford RJ, Kass DA, Schulman SP, Russell SD (2015) Outcomes and worsening renal function in patients hospitalized with heart failure with preserved ejection fraction. Am J Cardiol 116:1534–1540

    Article  PubMed  Google Scholar 

  21. Wijns W, Serruys PW, Slager CJ, Grimm J, Krayenbuehl HP, Hugenholtz PG, Hess OM (1986) Effect of coronary occlusion during percutaneous transluminal angioplasty in humans on left ventricular chamber stiffness and regional diastolic pressure-radius relations. J Am Coll Cardiol 7:455–463

    Article  PubMed  CAS  Google Scholar 

  22. Charlat ML, O’Neill PG, Hartley CJ, Roberts R, Bolli R (1989) Prolonged abnormalities of left ventricular diastolic wall thinning in the “stunned” myocardium in conscious dogs: time course and relation to systolic function. J Am Coll Cardiol 13:185–194

    Article  PubMed  CAS  Google Scholar 

  23. Acikel S, Akdemir R, Kilic H, Cagirci G, Dogan M, Yesilay AB, Yeter E (2015) Diastolic dysfunction and contrast-induced nephropathy in patients undergoing coronary angiography. Herz 40(Suppl 3):254–259

    Article  PubMed  Google Scholar 

  24. Koo HM, Doh FM, Ko KI, Kim CH, Lee MJ, Oh HJ, Han SH, Kim BS, Yoo TH, Kang SW, Choi KH (2013) Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: a retrospective cohort study. BMC Nephrol 14:146

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Ali-Hasan-Al-Saegh S, Mirhosseini SJ, Ghodratipour Z, Sarrafan-Chaharsoughi Z, Rahimizadeh E, Karimi-Bondarabadi AA, Haddad F, Shahidzadeh A, Mahdavi P, Dehghan AM, Tahernejad M, Shahidzadeh A, Dehghan H, Ghanei A, Lotfaliani M, Weymann A, Zeriouh M, Popov AF, Sabashnikov A (2017) Strategies preventing contrast-induced nephropathy after coronary angiography: a comprehensive meta-analysis and systematic review of 125 randomized controlled trials. Angiology 68:389–413

    Article  PubMed  CAS  Google Scholar 

  26. Subramaniam RM, Suarez-Cuervo C, Wilson RF, Turban S, Zhang A, Sherrod C, Aboagye J, Eng J, Choi MJ, Hutfless S, Bass EB (2016) Effectiveness of prevention strategies for contrast-induced nephropathy: a systematic review and meta-analysis. Ann Intern Med 164:406–416

    Article  PubMed  Google Scholar 

  27. Cerisano G, Buonamici P, Parodi G, Santini A, Moschi G, Valenti R, Migliorini A, Colonna P, Bellandi B, Gori AM, Antoniucci D (2017) Early changes of left ventricular filling pattern after reperfused ST-elevation myocardial infarction and doxycycline therapy: insights from the TIPTOP trial. Int J Cardiol 240:43–48

    Article  PubMed  Google Scholar 

  28. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794

    Article  PubMed  CAS  Google Scholar 

  29. Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Généreux P, Nikolsky E, Brener SJ, Witzenbichler B, Guagliumi G, Clark AE, Fahy M, Xu K, Brodie BR, Stone GW (2014) Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J 35:1533–1540

    Article  PubMed  CAS  Google Scholar 

  30. Yuan Y, Qiu H, Hu XY, Luo T, Gao XJ, Zhao XY, Zhang J, Wu Y, Yan HB, Qiao SB, Yang YJ, Gao RL (2017) Risk factors of contrast-induced acute kidney injury in patients undergoing emergency percutaneous coronary intervention. Chin Med J (Engl) 130:45–50

    Article  Google Scholar 

  31. Zhang MM, Lv QZ, Li XY (2017) Drug effects and clinical investigations for contrast-induced nephropathy after coronary angiography or percutaneous coronary intervention in patients with diabetes. Am J Ther 24:e423–e430

    Article  PubMed  Google Scholar 

  32. Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I, Grazi M, Veglia F, Bartorelli AL (2004) Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 44:1780–1785

    Article  PubMed  Google Scholar 

  33. Turan B, Erkol A, Gül M, Fındıkçıoğlu U, Erden İ (2015) Effect of contrast-induced nephropathy on the long-term outcome of patients with non-ST segment elevation myocardial infarction. Cardio Renal Med 5:116–124

    Article  CAS  Google Scholar 

  34. Bao Y, Ma X, Li H, Zhou M, Hu C, Wu H, Tang J, Hou X, Xiang K, Jia W (2010) Glycated haemoglobin A1c for diagnosing diabetes in Chinese population: cross sectional epidemiological survey. BMJ 340:c2249

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This work was supported by a research financial support project of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and the fund of West China Psychiatric Association to Beibei Han. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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  1. Beibei Han and Yongguang Li contributed equally to this study.

Affiliations

  1. Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, People’s Republic of China

    Beibei Han, Yongguang Li, Zhifeng Dong, Qing Wan, Hong Shen, Jingbo Li, Meng Wei & Chengxing Shen

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  1. Beibei Han
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  2. Yongguang Li
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  3. Zhifeng Dong
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Han, B., Li, Y., Dong, Z. et al. Diastolic dysfunction predicts the risk of contrast-induced nephropathy and outcome post-emergency percutaneous coronary intervention in AMI patients with preserved ejection fraction. Heart Vessels 33, 1149–1158 (2018). https://doi.org/10.1007/s00380-018-1165-x

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Keywords

  • Acute myocardial infarction
  • Contrast-induced nephropathy
  • Diastolic dysfunction
  • Doppler echocardiography