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Left ventricular end diastolic pressure and contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
Cardiovasc Revasc Med. 2018 09; 19(6S):16-20.CR

Abstract

BACKGROUND

Left ventricular end-diastolic pressure (LVEDP) reflects ventricular performance and volume status. We sought to analyze the relationship between LVEDP and the incidence of contrast-induced acute kidney injury (AKI) in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI).

METHODS

Between January 2006 and December 2008, a total of 254 patients presenting with an acute coronary syndrome had the LVEDP assessed prior to the intervention. Contrast-induced AKI was defined as an increase in serum creatinine ≥25% from baseline or an absolute increase of >0.5 mg/dL from baseline. Patients were divided into three groups according to baseline LVEDP (<12 mmHg, 12-20 mmHg and > 20 mmHg). Baseline clinical, angiographic and procedural characteristics, as well as serum creatinine and estimated glomerular filtration rate (eGFR) at baseline and at 24, 48 and 72 h were retrospectively collected.

RESULTS

Baseline clinical characteristics were similar in all three groups with the exception of lower left ventricular ejection fraction in patients with elevated LVEDP (p = 0.02). Among the 17 patients with an LVEDP < 12 mmHg, only one (5.9%) developed AKI; among the 82 patients with an LVEDP = 12-20 mmHg, 15 (18.3%) developed AKI; and among the 155 patients with an LVEDP > 20 mmHg, only 22 developed AKI (13.6%). There was no correlation between LVEDP and the change in GFR at 24 h and at 48 h. Further comparison between the group of patients that developed contrast induced AKI versus those that did not, showed a that there was a significantly lower baseline left ventricular ejection fraction (LVEF) among patients that developed contrast induced AKI compared to those that did not (41.4% vs. 48.3%, p = 0.045, respectively).

CONCLUSIONS

In patients with acute coronary syndrome undergoing PCI, baseline LVEDP was not associated with contrast-induced AKI. However patients with reduced ejection fraction seemed to be at a higher risk of developing AKI. More studies are needed to assess the relationship between LVEDP, LVEF and the risk of developing contrast induced AKI.

Authors+Show Affiliations

Department of Medicine, Rhode Island Hospital - Brown University, Providence, RI, United States of America.Division of Cardiovascular Diseases, Stony Brook Hospital, Stony Brook, NY, United States of America.Division of Cardiovascular Diseases, Stony Brook Hospital, Stony Brook, NY, United States of America.Division of Cardiology, Southside Hospital, Northwell Health, Bay Shore, NY, United States of America. Electronic address: gruberg67@hotmail.com.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29929842

Citation

Lima, Fabio V., et al. "Left Ventricular End Diastolic Pressure and Contrast-induced Acute Kidney Injury in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention." Cardiovascular Revascularization Medicine : Including Molecular Interventions, vol. 19, no. 6S, 2018, pp. 16-20.
Lima FV, Singh S, Parikh PB, et al. Left ventricular end diastolic pressure and contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Cardiovasc Revasc Med. 2018;19(6S):16-20.
Lima, F. V., Singh, S., Parikh, P. B., & Gruberg, L. (2018). Left ventricular end diastolic pressure and contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Cardiovascular Revascularization Medicine : Including Molecular Interventions, 19(6S), 16-20. https://doi.org/10.1016/j.carrev.2018.06.002
Lima FV, et al. Left Ventricular End Diastolic Pressure and Contrast-induced Acute Kidney Injury in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Cardiovasc Revasc Med. 2018;19(6S):16-20. PubMed PMID: 29929842.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left ventricular end diastolic pressure and contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention. AU - Lima,Fabio V, AU - Singh,Suraj, AU - Parikh,Puja B, AU - Gruberg,Luis, Y1 - 2018/06/09/ PY - 2018/04/16/received PY - 2018/05/10/revised PY - 2018/06/04/accepted PY - 2018/6/23/pubmed PY - 2019/8/14/medline PY - 2018/6/23/entrez SP - 16 EP - 20 JF - Cardiovascular revascularization medicine : including molecular interventions JO - Cardiovasc Revasc Med VL - 19 IS - 6S N2 - BACKGROUND: Left ventricular end-diastolic pressure (LVEDP) reflects ventricular performance and volume status. We sought to analyze the relationship between LVEDP and the incidence of contrast-induced acute kidney injury (AKI) in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). METHODS: Between January 2006 and December 2008, a total of 254 patients presenting with an acute coronary syndrome had the LVEDP assessed prior to the intervention. Contrast-induced AKI was defined as an increase in serum creatinine ≥25% from baseline or an absolute increase of >0.5 mg/dL from baseline. Patients were divided into three groups according to baseline LVEDP (<12 mmHg, 12-20 mmHg and > 20 mmHg). Baseline clinical, angiographic and procedural characteristics, as well as serum creatinine and estimated glomerular filtration rate (eGFR) at baseline and at 24, 48 and 72 h were retrospectively collected. RESULTS: Baseline clinical characteristics were similar in all three groups with the exception of lower left ventricular ejection fraction in patients with elevated LVEDP (p = 0.02). Among the 17 patients with an LVEDP < 12 mmHg, only one (5.9%) developed AKI; among the 82 patients with an LVEDP = 12-20 mmHg, 15 (18.3%) developed AKI; and among the 155 patients with an LVEDP > 20 mmHg, only 22 developed AKI (13.6%). There was no correlation between LVEDP and the change in GFR at 24 h and at 48 h. Further comparison between the group of patients that developed contrast induced AKI versus those that did not, showed a that there was a significantly lower baseline left ventricular ejection fraction (LVEF) among patients that developed contrast induced AKI compared to those that did not (41.4% vs. 48.3%, p = 0.045, respectively). CONCLUSIONS: In patients with acute coronary syndrome undergoing PCI, baseline LVEDP was not associated with contrast-induced AKI. However patients with reduced ejection fraction seemed to be at a higher risk of developing AKI. More studies are needed to assess the relationship between LVEDP, LVEF and the risk of developing contrast induced AKI. SN - 1878-0938 UR - https://www.unboundmedicine.com/medline/citation/29929842/Left_ventricular_end_diastolic_pressure_and_contrast_induced_acute_kidney_injury_in_patients_with_acute_coronary_syndrome_undergoing_percutaneous_coronary_intervention_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-8389(18)30245-8 DB - PRIME DP - Unbound Medicine ER -