Inverse correlation between left ventricular end-diastolic pressure and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention.

Abstract

There is a rising incidence of contrast-induced nephropathy (CIN), which is defined as either a 25% relative increase or an absolute increase of 0.5mg/dL (44.2µmol/L) in the serum creatinine (Scr) level at 48-72h after administration of iodinated contrast media (CM). We investigated the relationship between left ventricular end-diastolic pressure (LVEDP) and CIN in patients undergoing percutaneous coronary intervention (PCI). A total of 431 consecutive patients with coronary artery disease undergoing PCI were divided into four groups based on LVEDP quartile cut-off points. Enrolled patients were given continuous intravenous infusion of normal saline starting 4h before PCI and lasting 24h. At the end of hydration administration, 20mg furosemide was slowly injected intravenously. Serum creatinine (Scr), creatinine clearance rate (Ccr), and glomerular filtration rate (GFR) were detected before and after PCI. There were significant differences in the incidences of CIN in the four groups: 10.25% in the Q1 group, 5.55% in the Q2 group, 5.31% in the Q3 group, and 1.06% in the Q4 group (P < 0.05). With increasing LVEDP, the incidence of CIN decreased significantly (OR 0.581, 95% CI 0.367-0.920). Received operating characteristic curve analysis of the predictive value of LVEDP for CIN produced area under the curve values was 0.641, with a sensitivity of 74.1% and specificity of 48%. The optimal LVEDP cut-off for the occurrence of CIN was 14.5mmHg. LVEDP correlated inversely with CIN in patients undergoing PCI.