Diastolic dysfunction is associated with an increased risk of postcontrast acute kidney injury

摘要

Study objective: Computed tomography (CT) is an important imaging modality in diagnosing a variety of disorders. Although systolic heart failure is a well-known risk factor for postcontrast acute kidney injury (PC-AKI), few studies have evaluated the association between diastolic dysfunction and PC-AKI. Therefore, the aim of our study was to investigate whether PC-AKI occurs more likely in patients with diastolic dysfuction. Methods: This retrospective study was conducted by collecting the data of patients who visited an emergency medical center between January 2008 and December 2014. Patients who underwent contrast-enhanced CT (CECT) in the emergency department and had undergone echocardiography within 1 month of CECT were included. We defined PC-AKI as an elevation in the serum creatinine level of ≥0.5 mg/dL or ≥25% within 72 hours after CECT. Results: We included 327 patients, aged 18 years and older, who had a CECT scan and underwent an echocardiography within 1 month of the CECT scan at our institute over 20 years. The mean value of estimated glomerular filtration rate and E/E 0 (early left ventricular filling velocity to early diastolic mitral annular velocity ratio) was 51.55 ± 7.66 mL·min 1 ·1.73 m 2 and 11.56 ± 5.33, respectively. A total of 32 patients (9.79%) developed PC-AKI. The prevalence of diabetes mellitus and chronic kidney disease was significantly higher in the PC-AKI group than in the non-PC-AKI group. Echocardiographic findings revealed that E/E 0 was significantly increased in patients with PC-AKI. The logistic regression analysis showed that a higher E/E 0 value (odds ratio [OR] 5.39, 95% confidence interval [CI] 1.51–25.23, P = .015) was a significant risk factor for PC-AKI. Conclusion: This study demonstrated that, among the echocardiographic variables, E/E 0 was an independent predictor of PC- AKI. This, in turn, suggests that diastolic dysfunction may be a useful parameter in PC-AKI risk stratification.