Acikel S, Akdemir R, Kilic H, Cagirci G, Dogan M, Yesilay A B, Yeter E
Department of Cardiology, Ministry of Health Dışkapı Yıldırım Beyazıt Research and Educational Hospital, 06110, Ankara, Turkey,
Herz. 2015 May;40 Suppl 3:254-9. doi: 10.1007/s00059-014-4173-3. Epub 2014 Nov 30.
It has been demonstrated that decreased left ventricular ejection fraction (LVEF) is associated with an increased risk of contrast-induced nephropathy (CIN). In this study, we aimed to assess whether there is a relationship between left ventricular (LV) diastolic dysfunction and renal function decline after coronary angiography (CAG).
The study consisted of two groups: group I, patients with normal diastolic function; group II, patients with cardiac symptoms and abnormal diastolic function. Serum creatinine (Crea) and glomerular filtration rates (GFR) were measured before and after 48 h of CAG.
After the procedure, serum Crea values were higher in group II compared with group I (p = 0.051). Postprocedural 48-h GFR values determined by Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) equations were lower in group II compared with group I (p = 0.016 and p = 0.003, respectively). Delta (Δ) ΔCrea and ΔGFR determined by the Cockcroft-Gault and MDRD equations were statistically higher in group II than in group I (p = 0.005, p = 0.052, p = 0.030). The presence of higher age (p = 0.025), E/E' lateral ratio (p = 0.030), and left atrial volume index (p = 0.05) were independent predictors of worsening renal function.
The presence of diastolic dysfunction may play a role in determining the risk of CIN in patients with normal LVEF.
已有研究表明，左心室射血分数（LVEF）降低与造影剂肾病（CIN）风险增加相关。在本研究中，我们旨在评估冠状动脉造影（CAG）后左心室（LV）舒张功能障碍与肾功能下降之间是否存在关联。
本研究分为两组：第一组为舒张功能正常的患者；第二组为有心脏症状且舒张功能异常的患者。在CAG前及CAG后48小时测量血清肌酐（Crea）和肾小球滤过率（GFR）。
术后，第二组的血清Crea值高于第一组（p = 0.051）。根据Cockcroft - Gault方程和肾脏疾病饮食改良（MDRD）方程测定的术后48小时GFR值，第二组低于第一组（分别为p = 0.016和p = 0.003）。根据Cockcroft - Gault方程和MDRD方程测定的ΔCrea和ΔGFR，第二组在统计学上高于第一组（p = 0.005、p = 0.052、p = 0.030）。年龄较大（p = 0.025）、E/E'侧壁比值较高（p = 0.030）和左心房容积指数较高（p = 0.05）是肾功能恶化的独立预测因素。
舒张功能障碍可能在确定LVEF正常患者的CIN风险中起作用。
