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. 2017 Jul 19:13:887-895.
doi: 10.2147/TCRM.S137654. eCollection 2017.

Association of left ventricular ejection fraction with contrast-induced nephropathy and mortality following coronary angiography or intervention in patients with heart failure

Kun Wang  1   2 , Hua-Long Li  1   2 , Wei-Jie Bei  1   2 , Xiao-Sheng Guo  1   2 , Shi-Qun Chen  1   2 , Sheikh Mohammed Shariful Islam  3 , Ji-Yan Chen  1   2 , Yong Liu  1   2 , Ning Tan  1   2
Affiliations

Association of left ventricular ejection fraction with contrast-induced nephropathy and mortality following coronary angiography or intervention in patients with heart failure

Kun Wang et al. Ther Clin Risk Manag. .

Abstract

Background: Left ventricular ejection fraction (LVEF) is the most widely used parameter to evaluate the cardiac function in patients with heart failure (HF). However, the association between LVEF and contrast-induced nephropathy (CIN) is still controversial. Therefore, the aim of this study is to evaluate the association of LVEF with CIN and long-term mortality following coronary angiography (CAG) or intervention in patients with HF.

Methods: We analyzed 1,647 patients with HF (New York Heart Association [NYHA] or Killip class >1) undergoing CAG or intervention, including 207 (12.57%) patients with reduced LVEF (HFrEF), 238 (14.45%) with mid-range LVEF (HFmrEF) and 1,202 (72.98%) with preserved LVEF (HFpEF). CIN was defined as an absolute increase of ≥0.5 mg/dL or a relative increase of ≥25% from baseline serum creatinine within 48-72 h after contrast medium exposure. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to identify the association between LVEF, CIN and long-term mortality, respectively.

Results: Overall, 225 patients (13.7%) developed CIN. Individuals with lower LVEF were more likely to develop CIN (HFrEF, HFmrEF and HFpEF: 18.4%, 21.8% and 11.2%, respectively; P<0.001), but without a significant trend after adjusting for the confounding factors (HFrEF vs HFpEF: odds ratio [OR] =1.01; HFmrEF vs HFpEF: OR =1.31; all P>0.05). However, advanced HF (NYHA class >2 or Killip class >1) was an independent predictor of CIN (adjusted OR =1.54, 95% confidence interval [CI], 1.07-2.22; P=0.019). During the mean follow-up of 2.3 years, reduced LVEF (HFrEF group) was significantly associated with increased mortality (HFrEF vs HFpEF: adjusted hazard ratio =2.88, 95% CI, 1.77-4.69; P<0.001).

Conclusion: In patients with HF undergoing CAG or intervention, not worsened LVEF but advanced HF was associated with an increased risk of CIN. In addition, reduced LVEF was an independent predictor of long-term mortality following cardiac catheterization.

Keywords: cardiac catheterization; contrast-induced nephropathy; heart failure; left ventricular ejection fraction.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Incidence of CIN in different definitions between left ventricular ejection fraction groups. Abbreviations: CIN, contrast-induced nephropathy; HFrEF, heart failure with reduced ejection fraction; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; CI-AKI, contrast-induced acute kidney injury.
Figure 2
Figure 2
Cumulative rate of all-cause mortality during the follow-up in patients with HFrEF, HFmrEF and HFpEF. Abbreviations: HFrEF, heart failure with reduced ejection fraction; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction.
Figure 3
Figure 3
Cumulative all-cause mortality of CIN and Non-CIN within the definition of (A) CIN0.5 or 25%, (B) CIN0.3 or 50%, (C) CIN0.5. Abbreviation: CIN, contrast-induced nephropathy.
See this image and copyright information in PMC

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