Echocardiographic correlates of left ventricular filling pressures and acute cardio-renal syndrome in ST segment elevation myocardial infarction patients.

Abstract

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). 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 72h 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>0.3mg/dl, or an increase in serum creatinine≥1.5 times baseline. 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. Among STEMI patients undergoing primary PCI, the early E/e' ratio>15 was associated with increased risk for AKI.