Association of left ventricular ejection fraction with contrast-induced nephropathy and mortality following coronary angiography or intervention in patients with heart failure

Abstract

BackgroundLeft ventricular ejection fraction (LVEF) is the most widely used parameter to evaluate the cardiac function in patients with heart failure (HF). However, the association between LVEF and contrast-induced nephropathy (CIN) is still controversial. Therefore, the aim of this study is to evaluate the association of LVEF with CIN and long-term mortality following coronary angiography (CAG) or intervention in patients with HF.MethodsWe analyzed 1,647 patients with HF (New York Heart Association [NYHA] or Killip class >1) undergoing CAG or intervention, including 207 (12.57%) patients with reduced LVEF (HFrEF), 238 (14.45%) with mid-range LVEF (HFmrEF) and 1,202 (72.98%) with preserved LVEF (HFpEF). CIN was defined as an absolute increase of ≥0.5 mg/dL or a relative increase of ≥25% from baseline serum creatinine within 48–72 h after contrast medium exposure. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to identify the association between LVEF, CIN and long-term mortality, respectively.ResultsOverall, 225 patients (13.7%) developed CIN. Individuals with lower LVEF were more likely to develop CIN (HFrEF, HFmrEF and HFpEF: 18.4%, 21.8% and 11.2%, respectively; P<0.001), but without a significant trend after adjusting for the confounding factors (HFrEF vs HFpEF: odds ratio [OR] =1.01; HFmrEF vs HFpEF: OR =1.31; all P>0.05). However, advanced HF (NYHA class >2 or Killip class >1) was an independent predictor of CIN (adjusted OR =1.54, 95% confidence interval [CI], 1.07–2.22; P=0.019). During the mean follow-up of 2.3 years, reduced LVEF (HFrEF group) was significantly associated with increased mortality (HFrEF vs HFpEF: adjusted hazard ratio =2.88, 95% CI, 1.77–4.69; P<0.001).ConclusionIn patients with HF undergoing CAG or intervention, not worsened LVEF but advanced HF was associated with an increased risk of CIN. In addition, reduced LVEF was an independent predictor of long-term mortality following cardiac catheterization.

Prevalence and Predictors of Contrast-Induced Nephropathy (CIN) in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Percutaneous Coronary Intervention (PCI): A Meta-Analysis

“…DM and the administration of CM are both associated with marked alterations of renal physiology, which include changes of the glomerular filtration rate (GFR) and renal hemodynamics, enhanced tubular transport activity and oxygen expenditure, and intensification of medullary hypoxia and reactive oxygen species (ROS) generation [23–25]. Deterioration of cardiac function contributes to hemodynamic instability, which reduces the effective blood flow to the kidney, consequently trigging renin-angiotensin stagnation, activating the sympathetic nervous system and increasing the level of inflammatory factors and oxygen free radicals, all of which contribute to the occurrence and development of CIN [26]. These mechanisms may partly explain why these risk factors including Killip class ≥2 and decreased left ventricular ejection fraction (%) (LVEF) may predict the occurrence of CIN.…”

Left ventricular ejection fraction and contrast induced acute kidney injury in patients undergoing cardiac catheterization: Results of retrospective chart review

“…as an independent risk factor for CI-AKI [4]. Nonetheless, the association between LVEF and contrast induced AKI is still controversial.…”

What is the most appropriate method for coronary sinus cannulation? The telescopic method or the electrophysiologic method?

“…The renal function of patients with congestive heart failure is affected due to many factors such as activation of the sympathetic nervous system, activation of the renin-angiotensin system, and an increase in anti-diuretic hormone (ADH) levels. Contrast agents increase the risk of contrast-induced nephropathy in patients with reduced renal function as well as increased heart failure [ 23 ]. In our study, the use of contrast media was not statistically significant, although the amount of contrast media was higher compared with the group in which coronary catheters were used.…”