Li Qiang, Chen Weihua, Shi Shanshan, Huang Haozhang, Lai Wenguang, Liu Liwei, Ying Ming, Wang Bo, Li Huanqiang, Huang Zhidong, Chen Liling, Chen Jiyan, Chen Shiqun, Liu Jin, Liu Yong
Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
Front Physiol. 2021 Sep 27;12:744735. doi: 10.3389/fphys.2021.744735. eCollection 2021.
Acute kidney injury (AKI) is a common complication after coronary angiography (CAG) and associated with heart failure (HF). Left ventricular (LV) remodeling is a vital process in the progression of HF. However, few studies investigate the relationship between AKI and LV remodeling. We included consecutive patients undergoing CAG from January 2007 to December 2018 at Guangdong Provincial People's Hospital (NCT04407936). AKI was defined as an absolute increase in serum creatinine (Scr) of ≥ 0.3mg/dl or a ≥ 50% increase in Scr from baseline within the first 48-72 h after the procedure. LV remodeling was defined as: (1) an absolute decrease in left ventricular ejection fraction (LVEF) of ≥ 10% compared to baseline, or (2) a follow-up LVEF < 40%. Univariate and multivariate logistical regressions were used to assess the association between AKI and LV remodeling. Of the 1,573 patients (62.2 ± 9.7 years, female 36.7%) included in the study, 231 (14.7%) had AKI. The incidence of LV remodeling was higher in patients with AKI than in those without AKI (24.7% vs. 14.5%). After adjusting for confounding, multivariate logistic regression showed that AKI was associated with a significantly higher risk of LV remodeling [adjusted odds ratio (aOR) 1.87; 95% CI, 1.30-2.66; < 0.001]. In addition, LV remodeling patients had higher all-cause mortality compared to non-LV remodeling patients (9.7% vs. 19.1%). Our data suggested that AKI is present in up to 15% of patients after CAG and that nearly a quarter of AKI patients suffered LV remodeling and AKI patients have a two-fold risk of developing LV remodeling than non-AKI patients. Our findings suggest that more active measures be taken not only to prevent AKI patient developing into LV remodeling, but to prevent patients undergoing CAG from developing AKI.
急性肾损伤（AKI）是冠状动脉造影（CAG）后常见的并发症，且与心力衰竭（HF）相关。左心室（LV）重构是HF进展中的一个重要过程。然而，很少有研究探讨AKI与LV重构之间的关系。我们纳入了2007年1月至2018年12月在广东省人民医院连续接受CAG的患者（NCT04407936）。AKI的定义为术后48 - 72小时内血清肌酐（Scr）绝对值增加≥0.3mg/dl或较基线水平增加≥50%。LV重构的定义为：（1）左心室射血分数（LVEF）较基线水平绝对降低≥10%，或（2）随访时LVEF < 40%。采用单因素和多因素逻辑回归分析评估AKI与LV重构之间的关联。在纳入研究的1573例患者（62.2±9.7岁，女性占36.7%）中，231例（14.7%）发生了AKI。发生AKI的患者LV重构发生率高于未发生AKI的患者（24.7%对14.5%）。在调整混杂因素后，多因素逻辑回归显示AKI与LV重构风险显著升高相关[调整后的优势比（aOR）为1.87；95%置信区间（CI）为1.30 - 2.66；P < 0.001]。此外，与未发生LV重构的患者相比，发生LV重构的患者全因死亡率更高（9.7%对19.1%）。我们的数据表明，CAG术后高达15%的患者存在AKI，近四分之一的AKI患者发生了LV重构，且AKI患者发生LV重构的风险是非AKI患者的两倍。我们的研究结果表明，不仅应采取更积极的措施预防AKI患者发展为LV重构，还应预防接受CAG的患者发生AKI。
