title: Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: a retrospective cohort study.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN.
  
  
  METHODS
  We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% in serum creatinine level during the 72 hours following PTCA.
  
  
  RESULTS
  CIN occurred in 64 patients (8.7%). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E' in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E' values of 8 and 15, CIN occurred in 42 (21.6%) patients in the highest tertile compared with 20 (4.0%) in the middle and 2 (4.3%) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E' was 0.751 (95% CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001).
  
  
  CONCLUSIONS
  This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.
authors.affiliation: Department of Internal Medicine, College of Medicine, Yonsei University, 134 Shinchon-dong, Seodaemun-gu, Seoul, Korea.
authors.forename: Hyang Mo
authors.initials: HM
authors.lastname: Koo
authors.forename: Fa Mee
authors.initials: FM
authors.lastname: Doh
authors.forename: Kwang Il
authors.initials: KI
authors.lastname: Ko
authors.forename: Chan Ho
authors.initials: CH
authors.lastname: Kim
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Lee
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Kim
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Kyu Hun
authors.initials: KH
authors.lastname: Choi
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D054144:Heart Failure, Diastolic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D003287:Contrast Media