Mustafa OZTURK, Mürsel ŞAHİN, Oğuzhan Ekrem TURAN, Merih KUTLU

Assessment of relationship between contrast-induced nephropathy and left ventricular myocardial performance index in patients at risk for nephropathy

Aim: Contrast induced nephropathy (CIN) is associated substantially with a risk of morbidity and mortality. The aim of this study wasto assess the left ventricular myocardial performance assessed by ‘Tei index’ on the development of contrast induced nephropathyin patients underwent coronary angiography.Material and Methods: Study population consist of patients who underwent coronary angiography and/or percutaneous coronaryintervention and baseline creatinine level 1 mg/dl above and/or having diabetes mellitus. 51 patient were included the study. Patientsdivided into two groups as CIN developed or not. CIN was defined as %25 and/or 0.5 mg/dl increase in basal serum creatinine levelsafter 48-72 hours exposure to contrast media. Conventional and tissue Doppler echocardiography was performed in all patientsprior to angiography. Tei index was calculated from tissue Doppler echocardiography data.Results: Two groups were defined as CIN-developed group (n =13, 62.5 ± 6.8 ) and CIN-undeveloped (n=38, 62.4±9.6 )group. Exceptgender, there is no difference in demographic characteristics between the study groups. Left ventricular (LV) systolic function suchas ejection fraction and tissue Doppler imaging Sm and basic LV diastolic function (E/A, Em/Am, DT) parameters were found to besimilar in both groups. Tissue Doppler-derived Tei index values did not differ significantly between the two groups (0.42 ± 0.09 vs0.46 ± 0.12, p = 0.25).Conclusion: The Tei index is inadequate for predicting the risk of developing nephropathy in patients at risk for contrast inducednephropathy with preserved ejection fraction.

PDF

___

1. McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention: Incidence, risk factors, and relationship to mortality. Am J Med 1997;103:368-75.
2. Dangas G, Iakovou I, Nikolsky E, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol 2005;95:13-9.
3. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002;105:2259-64.
4. Perrin T, Descombes E, Cook S. Contrast-induced nephropathy in invasive cardiology. Swiss Med Wkly 2012;142:w13608.
5. McCullough PA, Adam A, Becker CR, et al. Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol 2006;98:5-13K.
6. ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: Main results from the randomized acetylcysteine for contrast-induced nephropathy trial (ACT) Circulation 2011;124:1250-9.
7. Bolognese L, Falsini G, Schwenke C, et al. Impact of isoosmolar versus low-osmolar contrast agents on contrastinduced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the contrast media and nephrotoxicity following primary angioplasty for acute myocardial infarction [CONTRAST-AMI] Trial) Am J Cardiol 2012;109:67-74.
8. Chen SL, Zhang J, Yei F, et al. Clinical outcomes of contrastinduced nephropathy in patients undergoing percutaneous coronary intervention: A prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine. Int J Cardiol 2008;126:407-13.
9. Holscher B, Heitmeyer C, Fobker M, et al. Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled dialysis-versus-diuresis (DVD) trial. Can J Cardiol 2008;24:845-50.
10. Morcos SK, Thomsen HS, Webb JA. Contrast media induced nephrotoxicity: A consensus report. Contrast media safety committee of the european society of urogenital radiology (ESUR) Eur Radiol 1999;9:1602-13.
11. Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. The Iohexol Cooperative Study. Kidney Int 1995;47:254-61.
12. Manske CL, Sprafka JM, Strony JT, et al. Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med 1990;89:615-20.
13. Bartholomew BA, Harjai KJ, Dukkipati S, Boura JA, Yerkey MW, Glazier S, et al. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol 2004;93:1515-9.
14. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004;44:1393-9.
15. Tei C, Ling LH, Hodge DO, et al: New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function-a study in normals and dilated cardiomyopathy. J Cardiol 1995;26:357-66.
16. Murphy SW, Barrett BJ, Parfrey PS. Contrast nephropathy. J Am Soc Nephrol 2000;11:177-82.
17. Kırış A, Karaman K, Kırış G, et al. Left ventricular dyssynchrony and its effects on cardiac function in patients with newly diagnosed hypertension. Echocardiography 2012;29:914- 22.
18. Baykan M, Baykan EC, Turan S, et al. Assessment of left ventricular function and tei index by tissue doppler imaging in patients with slow coronary flow. Echocardiography 2009;26:1167-72.
19. Uluçay A, Tatli E. Myocardial performance index. Anadolu Kardiyol Derg 2008;8:143-8.
20. Baykan M, Erem C, Gedikli O, et al. Assessment of left ventricular diastolic function and tei index by tissue doppler imaging in patients with cushing’s syndrome. Echocardiography 2008;25:182-90.
21. Baykan M, Erem C, Erdogan T, et al. Assessment of left ventricular diastolic function and the tei index by tissue doppler imaging in patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 2007;66:483-8.
22. Orem C, Küçükosmanoğlu M, Hacihasanoğlu A, et al. Association of doppler-derived myocardial performance index with albuminuria in patients with diabetes. J Am Soc Echocardiogr 2004;17:1185-90.
23. Masugata H, Senda S, Goda F, Independent determinants of the tei index in hypertensive patients with preserved left ventricular systolic function. Int Heart J 2009;50:331-40. 1084