| Background and Objective: Contrast-induced nephropathy(CIN)is defined as impairment in renal function(an increased in serum creatinine by > 25% or 0.5mg/dL[44.2umol/L])occurring within 3days after the intravascular administration of contrast media and the absence of an alternative cause.However,chronic heart failure deterioration or acute heart failure patients often accompanied by in vivo neurotrophic mechanism of compensatory enhancement led to renal insufficiency.On this basis,we often perform angiography to determine the cause of heart failure or to exclude cardiovascular emergencies,which may lead to renal dysfunction is more serious in heart failure patients.In order to study the effect of contrast media on renal function in patients with heart failure,this study provided the basis for us to detect and treat renal dysfunction after angiography early,which also played a positive role for further improvement in the prognosis of heart failure.At the same time,the relationship between the effect of contrast media on renal function and cardiac ejection fraction in patients with heart failure was studied,and the experimental basis was given for angiography in heart failure patients with different ejection fraction.Methods: We collected a total of Fifty-Six patients from the First Affiliated Hospital of Dalian medical university during February 2016 to November 2016.Twenty-nine persons were enrolled as the simple heart failure(Sixteen men,Thirteen women,average age 63.45±13.52 years).Twelve heart failure with renal insufficiency,that is Cardiorenal syndrome(CRS)(Seven men,five women,average age 73.85±7.56 years).On the other hand,fifteen control persons were enrolled as normal control(Five men,Ten women,average age 67.33±9.65 years).The left ventricular ejection fraction(LVEF)was measured by echocardiography.BUN and Scr were measured before and after 24-48 hours of angiography.In this study,the estimated glomerular filtration rate(eGFR)was evaluated by using the improved MDRD method in China,and diagnosed CRS with heart failure and renal insufficiency eGFR <60ml / min × 1.73m~2.The patients with heart failure were divided into two groups by ejection fraction preserved or reduced.Twenty heart failure with preserved ejection fraction(7 males and 13 females,average age 72.35 ± 11.20 years).Twenty-two heart failure with reduced ejection fraction(16 males and 4 females,average age 60.90 ± 12.12 years).The correlation between the two groups and the difference of glomerular filtration rate before and after angiography was calculated.After the completion of data collection,statistical analysis was performed by SPSS17.0 statistical software.Results:1.There was no significant difference in Scr absolute value and relative value between the control group and the simple heart failure group(P> 0.05).There was no significant difference in Scr absolute value and relative value between the control group and the CRS group(P> 0.05).There was no significant difference in Scr absolute value and relative value between the simple heart failure group and the CRS group(P> 0.05).2.In the comparison within before and after angiography,in the simple heart failure group,BUN increased from(6.68 ± 2.01)umol / L to(7.24 ± 2.04)umol / L with 24 h,Scr increased from(75.21 ± 17.1)umol / L to(75.21 ± 18.22)umol / L with 24 h,eGFR decreased from(87.95 ± 30.21)ml/min×1.73m~2 to(85.81± 27.60)ml/min×1.73m~2 in 24 h,but their changes were not statistically significant(P> 0.05).In CRS group,BUN increased from(11.06±1.84)umol / L to(11.62±3.55)umol / L with 24 h,Scr increased from(109.09±15.89)umol / L to(116.42±25.58)umol / L with 24 h,eGFR decreased from(50.81±5.46)ml/min×1.73m~2 to(48.13±6.35)ml/min×1.73m~2 with 24 h,but their changes were not statistically significant(P> 0.05).In the control group the Scr significantly increased from(61.13 ± 12.68)umol / L to(65.2 ± 12.05)umol / L with 24 h,and the eGFR significantly decreased from(98.81 ± 12.37)ml/min×1.73m~2 to(93.40± 12.53)ml/min×1.73m~2 with 24h(P<0.05),however,the BUN slightly higher,but not statistically significant(P> 0.05).3.One case of CIN occurred in control group,the incidence was 6.7%,two cases of CIN occurred in the sinple heart failure group,the incidence was 6.9%,three cases of CIN occurred in the CRS group,the incidence rate was 25%.In contrast with the simple heart failure group and the control group,the incidence of CIN was slightly higher,but not statistically significant(P> 0.05).The incidence of CIN in the CRS group was higher than that in the control group and the simple heart failure group,but there was no significant difference(P> 0.05).4.In the control group,the absolute value of Scr increased 13 cases,accounting for 86.7%,the average increase of 4 ± 4.87 umol / L.The simple heart failure group,the absolute value of Scr increased 15 cases,accounting for 51.7%,the average increase 0.14 ± 9.94 umol / L.The CRS group,the absolute value of Scr increased 8 cases,accounting for 66.7%,the average increase of 7.67 ± 18.81 umol / L.5.The correlation analysis between ejection fraction preserved and ejection fraction reduced in patients with heart failure and difference between glomerular filtration rate,the rate correlation coefficient rs is 0.353 ?-0.205(P>0.05),which suggests that there was no significant difference in glomerular filtration rate before and after angiograph in patients with heart failure which had significantly different ejection fraction(P>0.05).Conclusion: 1.The use of low-dose contrast agent on the control group,the simple heart failure group and the CRS group of patients will cause a certain degree of renal dysfunction,manifested as elevated serum Scr levels,decreased glomerular filtration rate,CIN incidence increased.2.CIN could also occur in low risk patients with the risk assessment of contrast-induced nephropathy,but was still the highest incidence in the CRS patients.3.Contrasting agent on renal function damage with left ventricular ejection fraction in the heart failure patients was not directly related. |
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