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A new indicator of contrast-induced nephropathy in patients undergoing elective coronary angiography: tissue
1Department of Cardiology, Health Sciences University, Bursa City Hospital, Bursa, Turkey. drtufangunay@gmail.com.
Insights
A novel non-invasive index, the E/(Ea × Sa) ratio, can predict contrast-induced nephropathy (CIN) in patients undergoing elective coronary angiography (ECA). This tissue Doppler-derived measure offers a valuable risk assessment tool for CIN development.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Contrast-induced nephropathy (CIN) is a complication of coronary angiography.
- Hemodynamic instability, reflected by left ventricular end-diastolic pressure (LVEDP), contributes to CIN.
- Invasive LVEDP measurement is challenging and not always accessible.
Purpose of the Study:
- To assess the relationship between the tissue Doppler-derived E/(Ea × Sa) index and CIN.
- To determine if the E/(Ea × Sa) index can serve as a non-invasive predictor of CIN.
- To evaluate the E/(Ea × Sa) index as a surrogate for LVEDP in predicting CIN risk.
Main Methods:
- Retrospective study of 388 patients undergoing elective coronary angiography (ECA).
- CIN defined as a 25% or 0.5 mg/dL increase in serum creatinine within 72 hours post-ECA.
- Doppler echocardiography used to evaluate systolic and diastolic functions; Mehran score calculated.
Main Results:
- CIN incidence was 9.7%.
- A positive correlation existed between LVEDP and the E/(Ea × Sa) index (r = 0.691, p < 0.001).
- Higher E/(Ea × Sa) index (OR = 1.03, p < 0.001) and Mehran score (OR = 1.41, p < 0.001) independently predicted CIN. A threshold of >1.71 showed 75.7% sensitivity and 84.3% specificity (AUC = 0.825).
Conclusions:
- The non-invasively measured E/(Ea × Sa) index is a viable risk indicator for CIN in patients undergoing ECA.
- This index provides a practical alternative for assessing CIN risk.
- E/(Ea × Sa) index aids in identifying patients at higher risk for CIN post-angiography.
Objective:
Hemodynamic instability plays an important role in the development of contrast-induced nephropathy (CIN), which is an important complication of coronary angiography. Left ventricular (LV) end-diastolic pressure (LVEDP) accurately reflects hemodynamic changes. In clinical practice, measuring LVEDP invasively presents some challenges and is not always accessible. This study aimed to investigate the relationship between tissue Doppler-derived early diastolic conduction velocity (E)/[early mitral annular diastolic velocity (Ea), × peak systolic annular velocity (Sa)] index, an important surrogate for LVEDP, and CIN in patients undergoing elective coronary angiography (ECA).
Patients And Methods:
This retrospective study included 388 consecutive patients undergoing ECA. CIN was defined as a 25% or 0.5 mg/dL increase in serum creatinine compared to baseline values within 72 hours after ECA. Mehran score was calculated in all patients and systolic and diastolic functions were evaluated with Doppler echocardiography.
Results:
The incidence of CIN was 9.7%. There was a positive correlation between LV EDP levels and LV E/(Ea × Sa) index (r = 0.691, p < 0.001). Higher LV E/(Ea × Sa) index (OR = 1.03, p < 0.001) and Mehran score (OR = 1.41, p < 0.001) were independent predictors of CIN. The threshold value of LV E/(Ea × Sa) index in predicting CIN was > 1.71 with 75.7% sensitivity and 84.3% specificity (AUC = 0.825).
Conclusions:
In patients undergoing ECA, the non-invasively measured E/(Ea × Sa) index can be used as a risk indicator for CIN.
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