Contrast-induced acute kidney injury in patients undergoing cardiac resynchronization therapy-incidence and prognostic importance. Sub-analysis of data from randomized TRUST CRT trial

Jacek Kowalczyk, Radoslaw Lenarczyk, Oskar Kowalski, Tomasz Podolecki, Pawel Francuz, Patrycja Pruszkowska-Skrzep, Mariola Szulik, Michal Mazurek, Ewa Jedrzejczyk-Patej, Beata Sredniawa, Zbigniew Kalarus, Triple-Site Versus Standard Cardiac Resynchronization Trial (TRUST CRT) Investigators, Jacek Kowalczyk, Radoslaw Lenarczyk, Oskar Kowalski, Tomasz Podolecki, Pawel Francuz, Patrycja Pruszkowska-Skrzep, Mariola Szulik, Michal Mazurek, Ewa Jedrzejczyk-Patej, Beata Sredniawa, Zbigniew Kalarus, Triple-Site Versus Standard Cardiac Resynchronization Trial (TRUST CRT) Investigators

Abstract

Introduction: Because data on contrast-induced acute kidney injury (CI-AKI) in patients undergoing cardiac resynchronization therapy (CRT-D) are scarce, we aimed to assess the incidence, natural course and prognostic importance of this syndrome in CRT recipients.

Methods: Study population consisted of 100 consecutive patients enrolled into the Triple Site Versus Standard Cardiac Resynchronization (TRUST CRT) trial, who were treated with CRT-D. Two patients were excluded up to 3 months after randomization and not analysed further. CI-AKI was defined as a rise in serum creatinine of at least 26.5 μmol/L (0.3 mg/dL) within 48 h after contrast exposure, or at least 50% increase from the baseline value during index hospital stay with CRT-D implantation according to KDIGO Clinical Practice Guideline for Acute Kidney Injury.

Results: Among 98 subjects of TRUST CRT trial, 10 patients (10.2%) developed CI-AKI after CRT-D implantation. In patients with glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) on admission, the incidence of CI-AKI was almost twofold (15.4%) higher than in subjects with GFR ≥60 (8.3%). CRT-D recipients with CI-AKI had significantly higher mortality rate (50.0%) compared to those without CI-AKI (17.0%) during 30 months of follow-up (logrank p = 0.012). Multivariate Cox regression analysis showed CI-AKI as significant and independent risk factor for death in CRT-D recipients (hazard ratio 5.71; 95% CI 5.16-6.26; p = 0.001).

Conclusions: Contrast-induced acute kidney injury is a serious and frequent procedural complication of CRT-D implantation with a significant negative influence on long-term survival. The results suggest that clinical evaluation regarding renal function should be considered in CRT-D recipients, both before and after device implantation.

Trial registration: ClinicalTrials.gov NCT00814840.

Figures

Fig. 1
Fig. 1
Changes in renal function estimated with serum creatinine (a) and glomerular filtration rate (b) in CRT-D recipients with respect to CI-AKI occurrence. CI-AKI = contrast-induced acute kidney injury; CRT-D = cardiac resynchronization therapy defibrillator; FU = follow-up; NS = non-significant
Fig. 2
Fig. 2
Kaplan–Meier curves for cumulative survival in CRT-D recipients with respect to CI-AKI occurrence. CI-AKI = contrast-induced acute kidney injury; CRT-D = cardiac resynchronization therapy defibrillator

References

    1. Brignole, M., Auricchio, A., Baron-Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O.A. et al. (2013). 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Addenda. European Heart Journal.
    1. Vardas PE, Auricchio A, Blanc JJ, Daubert JC, Drexler H, Ector H, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: the Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. European Heart Journal. 2007;28:2256–2295. doi: 10.1093/eurheartj/ehm305.
    1. Thomsen HS, Morcos SK. Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) guidelines. British Journal of Radiology. 2003;76:513–518. doi: 10.1259/bjr/26964464.
    1. Kowalczyk J, Lenarczyk R, Kowalski O, Sredniawa B, Musialik-Lydka A, Gasior M, et al. Different types of renal dysfunction in patients with acute myocardial infarction treated with percutaneous coronary intervention. Journal of Interventional Cardiology. 2007;20:143–152. doi: 10.1111/j.1540-8183.2007.00253.x.
    1. KDIGO AKI Work Group. (2012). KDIGO clinical practice guideline for acute kidney injury. Kidney International. Supplement, 2, 1–138.
    1. Lameire N, Kellum JA, for the KDIGO AKI Guideline Work Group Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2) Critical Care. 2013;17:205. doi: 10.1186/cc11455.
    1. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. Journal of the American College of Cardiology. 2004;44:1393–1399.
    1. Cowburn PJ, Patel H, Pipes RR, Parker JD. Contrast nephropathy post cardiac resynchronization therapy: an under-recognized complication with important morbidity. European Journal of Heart Failure. 2005;7:899–903. doi: 10.1016/j.ejheart.2004.10.023.
    1. Tester GA, Noheria A, Carrico HL, Mears JA, Cha YM, Powell BD, et al. Impact of radiocontrast use during left ventricular pacemaker lead implantation for cardiac resynchronization therapy. Europace. 2012;14:243–248. doi: 10.1093/europace/eur282.
    1. Lenarczyk R, Kowalski O, Średniawa B, Pruszkowska-Skrzep P, Pluta S, Sokal A, et al. Triple-Site Versus Standard Cardiac Resynchronization Therapy Study (TRUST CRT): clinical rationale, design and implementation. Journal of Cardiovascular Electrophysiology. 2009;20:658–662. doi: 10.1111/j.1540-8167.2008.01394.x.
    1. Lenarczyk R, Kowalski O, Sredniawa B, Pruszkowska-Skrzep P, Mazurek M, Jędrzejczyk- Patej E, et al. Implantation feasibility, procedure-related adverse events and lead performance during 1-year follow-up in patients undergoing Triple-Site Cardiac Resynchronization Therapy: a substudy of TRUST CRT Randomized Trial. Journal of Cardiovascular Electrophysiology. 2012;23:1228–1236. doi: 10.1111/j.1540-8167.2012.02375.x.
    1. National Kidney Foundation K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. American Journal of Kidney Diseases. 2002;39:S1–S237.
    1. McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, et al. Epidemiology and prognostic implications of contrast-induced nephropathy. American Journal of Cardiology. 2006;98:5K–13K. doi: 10.1016/j.amjcard.2006.01.019.
    1. Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I, et al. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. Journal of the American College of Cardiology. 2004;44:1780–1785. doi: 10.1016/j.jacc.2004.07.043.
    1. McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, et al. Risk prediction of contrast-induced nephropathy. American Journal of Cardiology. 2006;98:27K–36K. doi: 10.1016/j.amjcard.2006.01.022.
    1. Lin G, Gersh BJ, Greene EL, Redfield MM, Hayes DL, Brady PA. Renal function and mortality following cardiac resynchronization therapy. European Heart Journal. 2011;32:184–190. doi: 10.1093/eurheartj/ehq403.
    1. Kreuz J, Horlbeck F, Linhart M, Mellert F, Fimmers R, Schrickel J, et al. Independent predictors of mortality in patients with advanced heart failure treated by cardiac resynchronization therapy. Europace. 2012;14:1596–1601. doi: 10.1093/europace/eus152.
    1. Verbrugge FH, Dupont M, Rivero-Ayerza M, de Vusser P, Van Herendael H, Vercammen J, et al. Comorbidity significantly affects clinical outcome after cardiac resynchronization therapy regardless of ventricular remodeling. Journal of Cardiac Failure. 2012;18:845–853. doi: 10.1016/j.cardfail.2012.09.003.
    1. Hosoda J, Ishikawa T, Matsushita K, Matsumoto K, Kimura Y, Miyamoto M, et al. Impact of renal insufficiency on long-term clinical outcome in patients with heart failure treated by cardiac resynchronization therapy. Journal of Cardiology. 2012;60:301–305. doi: 10.1016/j.jjcc.2012.06.001.
    1. Van Bommel RJ, Mollema SA, Borleffs CJ, Bertini M, Ypenburg C, Marsan NA, et al. Impaired renal function is associated with echocardiographic nonresponse and poor prognosis after cardiac resynchronization therapy. Journal of the American College of Cardiology. 2011;57:549–555. doi: 10.1016/j.jacc.2010.06.060.
    1. Mathew J, Katz R, St John Sutton M, Dixit S, Gerstenfeld EP, Ghio S, et al. Chronic kidney disease and cardiac remodelling in patients with mild heart failure: results from the REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction (REVERSE) study. European Journal of Heart Failure. 2012;14:1420–1428. doi: 10.1093/eurjhf/hfs135.
    1. Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J, et al. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. European Heart Journal. 2013;34:3547–3556. doi: 10.1093/eurheartj/eht290.
    1. Bilchick KC, Kamath S, DiMarco JP, Stukenborg GJ. Bundle-branch block morphology and other predictors of outcome after cardiac resynchronization therapy in Medicare patients. Circulation. 2010;122:2022–2030. doi: 10.1161/CIRCULATIONAHA.110.956011.
    1. Onishi T, Onishi T, Marek JJ, Ahmed M, Haberman SC, Oyenuga O, et al. Mechanistic features associated with improvement in mitral regurgitation after cardiac resynchronization therapy and their relation to long-term patient outcome. Circulation. Heart Failure. 2013;6:685–693. doi: 10.1161/CIRCHEARTFAILURE.112.000112.
    1. Di Biase L, Auricchio A, Mohanty P, Bai R, Kautzner J, Pieragnoli P, et al. Impact of cardiac resynchronization therapy on the severity of mitral regurgitation. Europace. 2011;13:829–838. doi: 10.1093/europace/eur047.
    1. Cabrera-Bueno F, Molina-Mora MJ, Alzueta J, Pena-Hernandez J, Jimenez-Navarro M, Fernandez-Pastor J, et al. Persistence of secondary mitral regurgitation and response to cardiac resynchronization therapy. European Journal of Echocardiography. 2010;11:131–137. doi: 10.1093/ejechocard/jep184.
    1. Richardson M, Freemantle N, Calvert MJ, Cleland JG, Tavazzi L, CARE-HF Study Steering Committee and Investigators Predictors and treatment response with cardiac resynchronization therapy in patients with heart failure characterized by dyssynchrony: a pre-defined analysis from the CARE-HF trial. European Heart Journal. 2007;28:1827–1834. doi: 10.1093/eurheartj/ehm192.
    1. Jaussaud J, Blanc P, Derval N, Bordachar P, Courregelongue M, Roudaut R, et al. Ventilatory response and peak circulatory power: new functional markers of response after cardiac resynchronization therapy. Archives of Cardiovascular Diseases. 2010;103:184–191. doi: 10.1016/j.acvd.2010.01.003.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться