Association Between Echocardiographic Index Of Left Ventricular Filling Pressure And Contrast Induced Acute Kidney Injury In ACS Patients Undergoing Selective Percutaneous Coronary Artery Intervention

Objective The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus(E/e’)is the most reliable noninvasive marker of left ventricular(LV)filling pressure.We investigated the association between the preoperative E/e’ and contrast induced acute kidney injury(CI-AKI)in acute coronary syndrome(ACS)patients undergoing selective percutaneous coronary artery intervention(PCI).Methods We conducted a retrospective study of 1042 consecutive ACS patients between March 2016 and December 2018 who underwent selective PCI.The serum creatinine level was measured before and within 48 h of contrast medium administration.CI-AKI was defined as an absolute increase of 0.3 mg/d L or a relative increase of 50%from baseline serum creatinine within 48 h of contrast medium administration.We divided patients into CI-AKI group and a non-CIAKI group.To evaluate the the association between the preoperative E/e’ and CI-AKI,multivariable logistic regression analysis was performed.Results CI-AKI occurred in 63 patients(6.05%).Compared with non-CIAKI group,patients with CI-AKI were older,had more comorbidities,had greater N-terminal pro-brain natriuretic peptide(NT-pro BNP),high sensitive Troponin-I(hs-Tn I),white blood cell count(WBC)and lower hemoglobin,estimated glomerular filtration rates(e GFR).Echocardiographic findings showed lower left ventricular ejection fraction(LVEF)and higher E/e’ in patients with CI-AKI.In multivariate logistic regression models,E/e’ ratio was independently associated with CI-AKI(OR:2.272,95%CI:1.212～4.257,P=0.01 as a categorical variable / OR:1.132,95%CI:1.067～1.201,P<0.001 as a continuous variable).In addition,the area under the receiver operating characteristic curve of E/e’ was 0.765(95%CI:0.738～0.791,P<0.001).Conclusion Among ACS patients undergoing selective PCI,a preoperative E/e’ ratio>15 was an independent predictor of CI-AKI.Measurement of the preoperative E/e’ratio may help to assess the risk of CI-AKI.