title: Echocardiographic correlates of left ventricular filling pressures and acute cardio-renal syndrome in ST segment elevation myocardial infarction patients.
abstract: OBJECTIVE
  Increased transmitral flow velocity (E) to the early mitral annulus velocity (e') ratio (E/e'), signifying increased cardiac filling pressure, was previously found to be associated with deterioration of renal function in patients with congestive heart failure. No study, however, included patients with acute myocardial ischemia. We hypothesized that elevated E/e' ratio would be associated with an increased risk of acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  We conducted a retrospective study of 804 consecutive STEMI patients between June 2012 and December 2015 who underwent primary PCI and had a comprehensive echocardiographic examination performed within 72 h of hospital admission. Patients were stratified according to E/e' ratio above and ≤15, and assessed for AKI using the KDIGO criteria, defined as either a serum creatinine rise >0.3 mg/dl, or an increase in serum creatinine ≥1.5 times baseline.
  
  
  RESULTS
  Patients with E/e' ratio >15 had lower left ventricular (LV) ejection fraction, higher systolic pulmonary artery pressures, as well as right atrial pressures, and demonstrated worse in-hospital outcomes. Patients with E/e' ratio >15 had more AKI complicating STEMI (27 vs. 7 %; p < 0.001). In multivariate logistic regression model, E/e' ratio >15 was independently associated with AKI (OR = 1.87, 95 % CI 0.99-3.52; p = 0.05). Other variables associated with AKI included diabetes, LV ejection fraction, and glomerular filtration rate.
  
  
  CONCLUSIONS
  Among STEMI patients undergoing primary PCI, the early E/e' ratio >15 was associated with increased risk for AKI.
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Flint
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Natalia
authors.initials: N
authors.lastname: Kaufman
authors.affiliation: Department of Nephrology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Gal-Oz
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Gilad
authors.initials: G
authors.lastname: Margolis
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. kobyshacham@gmail.com.
authors.forename: Yacov
authors.identifier: http://orcid.org/0000-0003-0805-3185
authors.initials: Y
authors.lastname: Shacham
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D059347:Cardio-Renal Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
keywords: Acute kidney injury; Left ventricular filling pressures; Percutaneous coronary intervention; ST elevation myocardial infarction