Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: a retrospective cohort study.
Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: a retrospective cohort study.
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DOI：
10.1186/1471-2369-14-146
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发表时间：
2013-07-13
期刊：
影响因子：
2.3
通讯作者：
Choi KH
中科院分区：
文献类型：
--
作者：
Koo HM;Doh FM;Ko KI;Kim CH;Lee MJ;Oh HJ;Han SH;Kim BS;Yoo TH;Kang SW;Choi KH
造影剂肾病（CIN）是医院获得性急性肾损伤的第三大原因，并且与不良的长期临床结局相关。虽然收缩性心力衰竭是CIN的一个众所周知的危险因素，但尚未有研究评估舒张功能障碍与CIN之间的关联。我们对2009年1月至2010年12月期间在我院接受经皮腔内冠状动脉成形术（PTCA）并在手术后一个月内进行超声心动图检查的735例患者进行了回顾性研究。CIN定义为PTCA后72小时内血清肌酐水平升高≥ 0.5 mg/dL或≥ 25%。CIN发生率为8.7%。与非CIN患者相比，CIN患者年龄更大，合并症更多，并且在PTCA期间更频繁地放置主动脉内球囊反搏（IABP）。他们表现出较高的高敏C反应蛋白（hs-CRP）水平和较低的估计肾小球滤过率（eGFR）。超声心动图显示CIN组射血分数低于非CIN组，左房容积指数和E/E'高于非CIN组。按E/E'值8和15分为3组，最高三分位数CIN发生率为42例（21.6%），中间三分位数CIN发生率为20例（4.0%），最低三分位数CIN发生率为2例（4.3%）（p < 0.001）。在多变量logistic回归分析中，在校正年龄、糖尿病、造影剂剂量、IABP使用、eGFR、hs-CRP和超声心动图参数后，E/E' > 15被确定为CIN发展的独立危险因素[比值比（OR）2.579，95%可信区间（CI）1.082-5.964，p = 0.035]。此外，E/E'的受试者工作特征曲线下面积为0.751（95% CI 0.684-0.819，p < 0.001），与射血分数和左房容积指数的受试者工作特征曲线下面积（分别为0.739和0.656，p < 0.001）相当。这项研究表明，在超声心动图变量中，E/E'是CIN的独立预测因素。这反过来表明，舒张功能障碍可能是一个有用的参数，在CIN的危险分层。
Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN. We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% in serum creatinine level during the 72 hours following PTCA. CIN occurred in 64 patients (8.7%). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E’ in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E’ values of 8 and 15, CIN occurred in 42 (21.6%) patients in the highest tertile compared with 20 (4.0%) in the middle and 2 (4.3%) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E’ > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E’ was 0.751 (95% CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001). This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.