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1.
PLoS One ; 18(1): e0280279, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36608042

RESUMO

BACKGROUND: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most serious complications of ERCP. Various procedures can reduce the incidence of PEP, such as wire-guided cannulation, prophylactic pancreatic stent placement, and pretreatment anal insertion of NSAIDs. Recently, iso-osmolar contrast media (IOCM) have been used for ERCP in several hospitals to reduce the risk of PEP in Japan. However, the effect of IOCM is uncertain because few reports have examined IOCM in relation to PEP. AIM: This study aimed to investigate the relationship between contrast media used and the incidence of PEP. METHODS: This retrospective study included all qualifying patients who had undergone ERCP at Hamamatsu University Hospital between January 2012 and January 2020. This study examined whether there was a difference in the onset of PEP between patients administered IOCM and high osmolar contrast medium (HOCM). Propensity score matching was used to analyze patient characteristics and ERCP procedures. Amidotrizoic acid was used as HOCM and iodixanol as IOCM. RESULTS: ERCP was performed on 458 patients, and 830 procedures were conducted. After propensity score matching, 162 patients from the amidotrizoic acid group and 162 patients from the iodixanol group were selected. The incidence of PEP was 10.5% (17) in the amidotrizoic acid group and 9.3% (15) in the iodixanol group (P = 0.71). Changes in serum amylase levels post- and pre-ERCP were 240.6 ± 573.8 U/L and 142.7 ± 382.1 U/L in the amidotrizoic acid and iodixanol groups, respectively (P = 0.072). CONCLUSION: Iodixanol had no prophylactic effect on PEP and clinical outcomes.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Meios de Contraste , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Meios de Contraste/efeitos adversos , Estudos Retrospectivos , Diatrizoato de Meglumina , Fatores de Risco
2.
Int J Cardiovasc Imaging ; 39(1): 43-50, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36598687

RESUMO

The renal resistance index (RRI) has been demonstrated to be a useful parameter that can detect patients at a high risk of worsening of renal function (WRF). This study was designed to evaluate the role of the RRI in predicting WRF mediated by the intravascular administration of contrast media. We enrolled patients who were referred for coronary angiography. Renal arterial echo-color Doppler was performed to calculate the RRI. WRF was defined as an increase of > 0.3 mg/dL and at least 25% of the baseline value in creatinine concentration 24-48 h after coronary angiography. Among the 148 patients enrolled in this study, 18 (12%) had WRF. In the multivariate logistic analysis, the RRI was independently associated with WRF (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09-1.36; p = 0.001). After angiography, the RRI significantly increased in both patients with and without WRF. In the receiver operating characteristic curve analyses for WRF, the RRI at baseline and after angiography showed similar accuracy, and the best cutoff value for predicting WRF was 70%. In patients undergoing coronary angiography, the RRI is independently associated with WRF, probably because it provides more accurate information about cardiorenal pathophysiological factors and reflects kidney hemodynamic status and flow reserve.


Assuntos
Injúria Renal Aguda , Insuficiência Cardíaca , Humanos , Angiografia Coronária/efeitos adversos , Valor Preditivo dos Testes , Rim , Injúria Renal Aguda/diagnóstico , Meios de Contraste/efeitos adversos , Creatinina , Prognóstico
3.
Medicine (Baltimore) ; 102(2): e32629, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36637929

RESUMO

The triglyceride glucose (TyG) index is an indicator of insulin resistance and associated with increased risk of diabetes mellitus and cardiovascular events. Our study investigates the correlation between TyG index and contrast induced nephropathy (CIN) in non-diabetic patients with non-ST elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). 350 non-diabetic NSTEMI patients (183, 52.3% male) undergoing PCI were retrospectively enrolled. The enrolled cohort was divided into 2 groups based on the calculated TyG index, namely values < 8.65 or higher. CIN was defined as an increase in serum creatinine > 25% or 0.5 mg/dL from baseline in the first 48 to 72 hours after PCI. A total of 56 (16%) cases of CIN were diagnosed. In contrast to patients with lower TyG indexes, patients with higher TyG indexes (≥8.65) had a higher frequency of CIN, 9.5%. versus 20.8% respectively (P .004). Patients with CIN also had higher TyG indexes (8.74 ±â€…0.12 vs 8.67 ±â€…0.11, P < .001). In addition, TyG index, age, and glomerular filtration rate were identified as independent risk factors for CIN in logistic regression model (OR: 2.5 CI: 1.3-4.6, P .006, OR: 1.0 CI: 1.0-1.1, P < .001, OR: 1.0 KI: 1.03-1.06, P .025). In the ROC analysis, the area under the curve predictive of CIN was 0.666 (P < .001, 95% [CI] 0.58-0.75) with a cutoff value of 8.69 (sensitivity 71,4%, specificity 55.1%) TyG index. Higher TyG indexes are associated with an increased risk of CIN in non-diabetic patients with NSTEMI.


Assuntos
Nefropatias , Infarto do Miocárdio sem Supradesnível do Segmento ST , Intervenção Coronária Percutânea , Humanos , Masculino , Feminino , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Glucose , Triglicerídeos , Estudos Retrospectivos , Meios de Contraste/efeitos adversos , Nefropatias/diagnóstico , Fatores de Risco , Medição de Risco
4.
Intern Emerg Med ; 18(1): 67-76, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36539602

RESUMO

To assess the efficacy of modified hydration on contrast-associated acute kidney injury (CA-AKI) in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (pPCI). A total of 438 patients were randomly assigned to 2 groups. The traditional hydration group (group I) was given at a rate of 1 ml/kg/h for 24 h, and the modified hydration group (group II) was given at a rate of 3 ml/kg/h in the first 4 h, and then reduced to 1 ml/kg/h for 12 h. 0.3 mg/kg of furosemide was given 1-h after hydration. The primary endpoint was the incidence of CA-AKI, and the secondary endpoint was the incidence of major adverse cardiovascular events (MACEs) during a median of 22.4 months (IQR 9.6, 32.6 months) follow-up. The incidence of CA-AKI was 8.7%. Among these, Group I was 9.1% and group II was 8.2%, respectively. There was no significant difference in CA-AKI and creatinine levels between the two hydration groups. Multivariable logistics regression analysis revealed that creatinine, white blood cells, and N-terminal pro-B-type natriuretic peptide were associated with CA-AKI. Moreover, CA-AKI was an independent predictor for all-cause death and cardiac death during the follow-up period. The modified hydration may reduce the incidence of CA-AKI, although this difference was not statistically significant. The relationship between CA-AKI and mortality strengthened as creatinine times above baseline increased. Mitigating the occurrence of CA-AKI may reduce all-cause death and cardiac death.


Assuntos
Injúria Renal Aguda , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Meios de Contraste/efeitos adversos , Creatinina , Fatores de Risco , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/epidemiologia
5.
J Cardiovasc Magn Reson ; 24(1): 67, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36451214

RESUMO

BACKGROUND: Methamphetamine-associated cardiomyopathy (MA-CMP) is an increasingly recognised aetiology of cardiomyopathy. Cardiovascular magnetic resonance (CMR) is a specialised cardiac imaging modality commonly used in assessment of cardiomyopathy. We aimed to identify specific CMR features associated with MA-CMP. METHODS: A retrospective cohort study of CMR scans was performed in a single centre between January 2015 and December 2020. Thirty patients with MA-CMP who had undergone CMR were identified. MA-CMP was defined as those with a history of significant methamphetamine use hospitalised with acute decompensated heart failure (other causes of cardiomyopathy excluded). A retrospective analysis of index admission CMRs was performed. All studies were performed on a 1.5 T CMR scanner. RESULTS: The mean age of MA-CMP patients was 43.7 ± 7.5 years, and 86.7% were male. The mean left ventricular (LV) volume obtained in this cohort was consistent with severe LV dilatation (LV end-diastolic volume (334 ± 99 ml); LV end-systolic volume: 269 ± 98 ml), whilst the right ventricular (RV) volume indicated moderate-to-severe dilatation (RV end-diastolic volume: 272 ± 91 ml; RV end-systolic volume: 173 ± 82 ml). Mean LV ejection fraction (20.9 ± 9.2%) indicated severe LV dysfunction, with moderate-to-severe RV dysfunction also detected (RV ejection fraction: 29.4 ± 13.4%). 22 patients (73.3%) had myocardial late gadolinium enhancement (LGE), of which 59.1% were located in the mid-wall, with all of these involving the interventricular septum. 22.7% displayed localised regions of sub-endocardial LGE in a variety of locations, and 18.2% had transmural regions of LGE that were located in the inferior and inferolateral segments. 6 patients (20%) had intracardiac thrombus (4 LV, 2 both LV and RV). CONCLUSION: MA-CMP was associated with severe biventricular dilatation and dysfunction, with a high prevalence of intraventricular thrombus. This cohort study highlights that MA-CMP patients have a high prevalence of CMR findings.


Assuntos
Cardiomiopatias , Insuficiência Cardíaca , Metanfetamina , Septo Interventricular , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Metanfetamina/efeitos adversos , Estudos de Coortes , Meios de Contraste/efeitos adversos , Gadolínio , Valor Preditivo dos Testes , Cardiomiopatias/induzido quimicamente , Cardiomiopatias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Ventrículos do Coração , Insuficiência Cardíaca/induzido quimicamente , Insuficiência Cardíaca/diagnóstico por imagem , Citidina Monofosfato
6.
J Vasc Interv Radiol ; 33(11): 1329-1334, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36511304

RESUMO

This study evaluated the utility of carbon dioxide (CO2) in angiography for the detection of lower gastrointestinal arterial bleeding initially occult to angiography with iodinated contrast media. Fourteen patients underwent CO2-enhanced angiography. In all patients, extravasation was identified by contrast-enhanced computed tomography but not by initial iodinated contrast-enhanced angiography. After iodinated contrast-enhanced angiography, CO2-enhanced angiography was performed from the same catheter position. The detection capability for extravasation on CO2-enhanced angiography was evaluated. CO2-enhanced angiography allowed for the visualization of extravasation and subsequent transcatheter arterial embolization in 11 of 14 (79%) cases, with extravasation seen during either CO2-enhanced angiography (n = 8) or subsequent repeat iodinated contrast-enhanced angiography immediately after negative CO2-enhanced angiography (n = 3). Conservative treatment was performed in the remaining 3 cases. In conclusion, CO2-enhanced angiography appears useful for identifying occult lower gastrointestinal bleeding.


Assuntos
Angiografia , Dióxido de Carbono , Humanos , Dióxido de Carbono/efeitos adversos , Angiografia/efeitos adversos , Angiografia/métodos , Meios de Contraste/efeitos adversos , Artérias , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/diagnóstico por imagem
8.
Sci Rep ; 12(1): 21819, 2022 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-36528725

RESUMO

Cisplatin (CDDP)-induced nephrotoxicity (CIN) is dose-limiting. We revealed that co-administration of non-steroid anti-inflammatory drugs and baseline comorbidity of diabetes mellitus (DM) are associated with CIN development in the short hydration method; however, the results were accessorily obtained without appropriate power calculation. This study aimed to demonstrate the influence of DM complications on CIN incidence in a real-world setting. Lung cancer patients receiving CDDP (≥ 75 mg/m2)-containing regimens with a short hydration method (n = 227) were retrospectively evaluated. The patients were divided into control and baseline DM complication groups. The primary endpoint was the evaluation of CIN incidence between the groups. Propensity score-matching was performed to confirm the robustness of the primary analysis results. CIN occurred in 6.8% of control and 27.0% of DM patients, respectively, with a significant difference in all-patient populations (P = 0.001). In addition, variation of serum creatinine and creatinine clearance significantly worsened in DM patients. Similar results were obtained in a propensity-matched population. Multivariate logistic regression analysis found that DM complication is a singular risk factor for CIN development (adjusted odds ratio; 4.31, 95% confidence interval; 1.62-11.50, P = 0.003). In conclusion, our study revealed that baseline DM complications significantly worsen CIN.


Assuntos
Diabetes Mellitus , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Nefropatias , Insuficiência Renal , Humanos , Cisplatino/efeitos adversos , Estudos Retrospectivos , Pontuação de Propensão , Creatinina , Fatores de Risco , Nefropatias/induzido quimicamente , Meios de Contraste/efeitos adversos
9.
Medicina (Kaunas) ; 58(12)2022 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-36557073

RESUMO

Background and Objectives: Although epidural steroid injections are used as an effective treatment, this technique is associated with rare but serious ischemic complications, especially when particulate steroids are used. However, recent studies have reported that even if non-particulate steroids are used, particulates are formed by the interaction with some local anesthetics (LA), causing ischemic complications. This observational study evaluated commonly used combinations of non-particulate steroids and LA with contrast media via microscopic analysis and analyzed the chemical properties of each mixture to identify the correlation of particulate formation. Materials and Methods: Commonly used clinical non-particulate and particulate steroids, contrast media, and LA agent combinations were evaluated macroscopically and microscopically. The pH values were also measured at both room temperature (26 °C) and body temperature (36 °C). Where particulates were observed, the particulate size was measured. Results: Macroscopically, the mixture of non-particulate steroid and ropivacaine had a slightly cloudy appearance at all concentrations, but there was no visible particulate. However, when observed under a microscope, the pH-dependent particulate formation was observed at all concentration combinations tested. (0.1% ropivacaine: from 19 µm to 70 µm, and 0.2% ropivacaine: from 37 µm to 108 µm at room temperature (26 °C)). When contrast media was mixed or the temperature was raised to body temperature (36 °C), the number and size of the particulates decreased or dissolved. Conclusions: The combination of ropivacaine and dexamethasone, a non-particulate steroid, mainly used in epidural injections, forms particulates. However, when mixed with contrast media, particulates are dissolved because of changes in pH and factors affecting particulate formation. In fluoroscopy-guided injections, the use of contrast media could resolve particulate formation.


Assuntos
Meios de Contraste , Dor , Humanos , Ropivacaina/uso terapêutico , Meios de Contraste/efeitos adversos , Dor/tratamento farmacológico , Anestésicos Locais/efeitos adversos , Esteroides/uso terapêutico , Dexametasona/efeitos adversos
10.
J Ayub Med Coll Abbottabad ; 34(4): 771-777, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36566397

RESUMO

BACKGROUND: Contrast induced nephropathy (CIN) is a common complication seen after primary percutaneous coronary intervention (PCI) which can contribute to increased morbidity and mortality in patients of acute ST elevation myocardial infarction (STEMI). Aim of this study was to validate the TIMI Risk Index (TRI) for the risk stratification of CIN in patients undergone primary PCI. METHODS: Consecutive patients of STEMI undergone primary PCI at a tertiary care cardiac center were included for this study. Patients in Killip class IV at presentation, patients with history of any PCI and chronic kidney diseases were excluded from this study. TRI was calculated using the formula " " and post-procedure serum creatinine level increase of either 25% or 0.5 mg/dL was taken as CIN. RESULTS: A total of 507 patients were included in this study out of which 82.2% were males and 17.8% were females. In total 8.7% (44) patients developed CIN. In the receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) for TRI was found to be 0.717, [0.649-0.758] for the prediction of CIN. Sensitive, specificity, positive predictive value and negative predictive value of TRI >22.8 to predict the development of CIN were 59.09%, 76.69%, 19.55% and 95.19% respectively. CONCLUSIONS: TIMI risk index is and easy to calculate and readily accessible score which has good predictive value to evaluate the risk of CIN in primary PCI setting.


Assuntos
Nefropatias , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Masculino , Feminino , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Meios de Contraste/efeitos adversos , Fatores de Risco , Intervenção Coronária Percutânea/efeitos adversos , Medição de Risco , Nefropatias/induzido quimicamente
11.
Artigo em Inglês | MEDLINE | ID: mdl-36568875

RESUMO

Background: Postcontrast acute kidney injury (PC-AKI) is an adverse reaction to iodinated contrast agents. In this study, we investigated the use of fibrinogen-to-albumin ratio (FAR) as a novel inflammatory marker to track the development and progression of PC-AKI in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) after the implantation of drug-eluting stents (DESs). Methods: A total of 872 patients with NSTE-ACS were enrolled in this study. PC-AKI was identified when serum creatinine (SCr) levels increased >26.5 mol/L (0.3 mg/dL) or was 1.5 times the baseline level within 48-72 h of exposure to an iodinated contrast agent. The effects of different variables on PC-AKI were evaluated using univariate regression analysis. Multivariate logistic regression analysis was used to determine the independent predictors of PC-AKI. The predictive value of FAR was assessed by estimating the area under the receiver operating characteristic (ROC) curve. Results: In total, 114 (13.1%) patients developed PC-AKI. The patients with PC-AKI had lower albumin levels (40.5 ± 3.4 vs. 39.0 ± 3.5, P < 0.001), higher fibrinogen levels (3.7 ± 0.6 vs. 4.1 ± 0.5, P < 0.001), and higher FAR levels (9.2 ± 1.7 vs. 10.5 ± 1.7, P < 0.001) than those with non-PC-AKI. There were no significant differences in the preoperative SCr levels between the two groups. After adjusting for confounding factors, FAR was found to be an independent predictor of PC-AKI (OR = 1.478, 95% CI = 1.298-1.684, P < 0.001). ROC analysis revealed that for PC-AKI prediction, the area under the curve for FAR was 0.702. The optimum cut-off value of FAR was 10.0, with a sensitivity of 64.9% and a specificity of 69.8%. Moreover, FAR had a higher predictive value for PC-AKI than the Mehran score (0.702 vs. 0.645). Conclusion: Our study showed that elevated preoperative FAR was closely associated with the development of PC-AKI in patients with NSTE-ACS after implantation of DESs. Therefore, it may be worth monitoring FAR as a guide for using preventive measures to avoid the development of PC-AKI.


Assuntos
Síndrome Coronariana Aguda , Injúria Renal Aguda , Stents Farmacológicos , Humanos , Síndrome Coronariana Aguda/induzido quimicamente , Fatores de Risco , Meios de Contraste/efeitos adversos , Injúria Renal Aguda/induzido quimicamente , Fibrinogênio , Albuminas , Estudos Retrospectivos
12.
Endokrynol Pol ; 73(6): 913-916, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36519659

RESUMO

Metformin is a drug that has been widely used around the world for many years. Due to its properties, metformin is used in the treatment of carbohydrate disorders (in type 2 diabetes, prediabetes) and in insulin resistance syndromes (including polycystic ovary syndrome). Many patients using metformin, due to complications of carbohydrate metabolism disorders, including cardiovascular complications or other accompanying diseases, require cardiological or radiological diagnostics related to the administration of a contrast agent. The aim of this study is to summarize the recommendations regarding the use of metformin before procedures involving the use of contrast agents and to share our own experience in this area, based on observations of a large group of patients with cardiological diseases hospitalized at the Silesian Centre for Heart Diseases in Zabrze.


Assuntos
Diabetes Mellitus Tipo 2 , Resistência à Insulina , Metformina , Síndrome do Ovário Policístico , Feminino , Humanos , Metformina/efeitos adversos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Hipoglicemiantes/efeitos adversos , Meios de Contraste/efeitos adversos , Síndrome do Ovário Policístico/complicações
13.
J Int Med Res ; 50(12): 3000605221135857, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36539953

RESUMO

OBJECTIVE: Iodinated contrast medium is potentially nephrotoxic in susceptible individuals. The aim of this retrospective observational study was to determine the impact of hospital-wide implementation of a guideline to prevent contrast-associated acute kidney injury (CA-AKI) on quality of care and outcomes. METHODS: A hospital-wide guideline for management of patients known to be at risk of CA-AKI was implemented in April 2019. All patients who underwent coronary angiography at our institution between November 2018 and March 2019 (period 1, before introduction of the guideline) and between August and December 2019 (period 2, after introduction of the guideline) were enrolled. RESULTS: In total, 561 patients were enrolled for period 1 and 578 for period 2. CA-AKI was impossible to diagnose in many patients because of missing post-procedure creatinine control data. Preventive measures were initiated more often in period 2 than in period 1 and in older patients than in younger patients. Preventive measures were not initiated in at least 50% of patients at risk of CA-AKI despite implementation of the guideline. CONCLUSIONS: Management of patients at known risk of CA-AKI remains inadequate at our institution even after introduction of a guideline. Physicians should receive organized training in acute kidney injury.


Assuntos
Injúria Renal Aguda , Meios de Contraste , Humanos , Idoso , Angiografia Coronária/efeitos adversos , Fatores de Risco , Estudos Retrospectivos , Meios de Contraste/efeitos adversos , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/prevenção & controle
14.
BMC Nephrol ; 23(1): 416, 2022 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-36585656

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is a major risk factor for contrast induced acute kidney injury (CI-AKI) in chronic coronary syndrome (CCS) patients undergoing coronary catheterization. We aimed to evaluate the efficacy of phentolamine in prevention of CI-AKI in CKD and CCS patients undergoing percutaneous coronary catheterization for diagnostic angiography ± stenting. METHODS: Participants with CKD and CCS planned for percutaneous coronary catheterization were included, while participants with normal kidney functions were excluded. A consecutive sample of 107 participants (mean age 58.62 ± 8.96 years, 64.5% males) was selected, underwent diagnostic coronary angiography or percutaneous coronary intervention, and received either conventional CI-AKI prevention strategy (group 1) or periprocedural phentolamine and conventional CI-AKI prevention strategy (group 2). RESULTS: The percentages of study participants who had CI-AKI were 82.9% for group 1 and 17.1% for group 2, respectively. The incidence rate of CI-AKI was significantly lower in group 2 versus group 1 (p <  0.001). The urine output (ml/kg) and the urine output (ml/hour) within 72 hours post procedure was significantly higher in group 2 versus group 1 (t(105) = - 0.69, p <  0.001, t(105) = - 52.46, p < 0.001, respectively), the peak change in serum creatinine and the percentage of change relative to the baseline serum creatinine at 72 hours post procedure was significantly lower in group 2 versus group 1 (t(102) = 0.2, p 0.018, t(102) = 23.54, p < 0.001, respectively), and the incidence rate of major adverse cardiac and cerebrovascular events within 90 days post procedure was significantly lower in group 2 versus group 1 (t(102) = 1.168, P < 0.001), respectively. There was a statistically significant association of periprocedural phentolamine infusion with prevention of CI-AKI (OR = 0.041, 95% CI 0.0149-0.1128, P < 0.0001). CONCLUSION: Our study highlights the potential role of phentolamine for protection of the kidney in CKD patients planned for coronary catheterization. TRIAL REGISTRATION: Pan African Clinical Trial Registry Number: PACTR202209493847741. Date of Trial Registration: 22/09/2022.


Assuntos
Injúria Renal Aguda , Intervenção Coronária Percutânea , Insuficiência Renal Crônica , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Feminino , Fentolamina , Meios de Contraste/efeitos adversos , Estudos Prospectivos , Projetos Piloto , Creatinina , Angiografia Coronária/métodos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/induzido quimicamente , Fatores de Risco , Injúria Renal Aguda/diagnóstico , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Intervenção Coronária Percutânea/efeitos adversos
15.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 34(12): 1243-1247, 2022 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-36567576

RESUMO

OBJECTIVE: To investigate the effect of preoperative hemoglobin (Hb) level on the risk of developing acute kidney injury (AKI) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). METHODS: A retrospective study was conducted. The hospitalized patients diagnosed with AMI who underwent PCI from May 2015 to May 2020 in the department of cardiology in the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University were enrolled. According to the serum creatinine (SCr) level before and after interventional therapy, the patients were divided into an AKI group and a non-AKI group. The difference in patients' Hb levels between the AKI and non-AKI groups was compared. Univariate and multivariate Logistic regression analyses were used to analyze the effects of Hb levels on the risk of AKI after interventional therapy in patients with AMI. Kaplan-Meier survival curve was used to evaluate the effects of Hb levels on patients with AMI in all-cause death in the hospital. RESULTS: A total of 922 AMI patients were enrolled in this study, of which 165 patients (17.9%) developed AKI. Compared with the non-AKI group, female patients in the AKI group had a higher proportion [35.8% (59/165) vs. 26.9% (204/757)], older (age: 69.78±14.56 vs. 66.61±13.44), with a lower rate of smoking [42.4% (70/165) vs. 51.7% (391/757)] and a higher prevalence of hypertension [73.3% (121/165) vs. 63.5% (481/757)], however, the patients in AKI group also had a worse cardiac function [the proportion of Killip grade 3 or above was higher: 33.9% (56/165) vs. 13.9% (105/757)], lower Hb level (g/L: 127.61±22.18 vs. 132.79±19.45), and there were less patients using angiotensin converting enzyme inhibitor/angiotensin II receptor blocker [ACEI/ARB, 60.0% (99/165) vs. 74.5% (564/757)] and more patients using diuretics [24.8% (41/165) vs. 17.7% (134/757)] in AKI group, the differences were statistically significant (all P < 0.05). Compared with non-AKI group, patients in AKI group had a longer operation time [operation time > 60 minutes: 4.2% (7/165) vs. 1.5% (11/757)] and received more contrast media during the operative procedure [contrast media > 100 mL: 16.4% (27/165) vs. 3.6% (27/757)], the individuals had a higher rate of intra-operative hypotension [16.4% (27/165) vs. 8.2% (62/757)], and more patients were implanted more than 2 stents [8.5% (14/165) vs. 3.6% (27/757), all P < 0.05]. Univariate Logistic regression analysis suggested that each 1 g/L increase in preoperative Hb level was associated with a 1.2% decrease in the risk of postoperative AKI [odds ratio (OR) = 0.988, 95% confidence interval (95%CI) was 0.980-0.996, P = 0.003]. Meanwhile, for every 1 standard deviation increase in preoperative Hb level, the risk of postoperative AKI decreased by 22.1% (OR = 0.779, 95%CI was 0.661-0.918, P = 0.003). The patients were divided into low, medium and high concentration groups according to Hb levels (Hb levels were < 110 g/L, 110-150 g/L, ≥ 150 g/L, respectively), and multivariate Logistic regression analysis showed that the risk of AKI was significantly reduced in the high concentration group compared with that in the low concentration group (OR = 0.463, 95%CI was 0.241-0.888, P = 0.020). The Kaplan-Meier survival curve analysis indicated that the short term survival after coronary intervention in AMI patients with low Hb concentration was significantly lower than that in patients with medium and high Hb concentration (Log-Rank: χ2 = 23.215, P < 0.001). CONCLUSIONS: Preoperative lower Hb level is an independent risk factor for postoperative AKI in AMI patients. AMI patients with lower Hb levels have an increased risk of all-cause mortality within 1 month after AMI.


Assuntos
Injúria Renal Aguda , Hemoglobinas , Infarto do Miocárdio , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Meios de Contraste/efeitos adversos , Hemoglobinas/análise , Infarto do Miocárdio/sangue , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia
16.
Afr Health Sci ; 22(2): 629-637, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36407373

RESUMO

Background: There has been a demand for radiographers in Zambia to perform intravenous (IV) cannulation and administration of contrast media, a role which, traditionally, was radiologists'. This demand is due to a shortage of radiologists and an increase in demand for imaging examinations. This review aimed at synthesising relevant literature related to IV cannulation and administration of contrast media by radiographers to guide the training and practice in Zambia. Methods: A structured literature search was conducted in three online databases (PubMed/MEDLINE, CINAHL, and ScienceDirect), radiography journals, and cited references to identify research studies on IV cannulation and administration of contrast media by radiographers. Results: Seven studies were identified and included in this review. The findings are summarised under six themes: benefits and challenges, adoption of the extended role, infection control, safety and complications, medico-legal issues, and education and training. Our findings revealed that radiographer-led IV cannulation and administration of contrast media contribute positively to the management of imaging patients. Conclusion: The themes identified in this review could provide a template of where to base the establishment of the training programme and local guidelines. Before extending the role of radiographers, the scope of practice should be extended, and accredited training programme and local guidelines should be put in place.


Assuntos
Competência Clínica , Meios de Contraste , Humanos , Meios de Contraste/efeitos adversos , Zâmbia , Radiografia , Cateterismo
17.
J Med Case Rep ; 16(1): 421, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36384694

RESUMO

BACKGROUND: Gadolinium-based contrast agents are used extensively in magnetic resonance imaging to assist diagnosis of medical conditions. Despite their documented safety profile, severe adverse events do occur, and their documentation may serve to raise the awareness of the medical community. CASE PRESENTATION: We report the case of a 15-year-old white Latin American female patient admitted to the intensive care unit for acute respiratory distress syndrome following administration of gadolinium. She did not have rash or tongue swelling but developed hypotension responsive to fluid administration and severe hypoxemia. Chest computed tomography revealed bilateral pulmonary compromise with multiple confluent consolidations. She received methylprednisolone and noninvasive ventilatory support including bilevel positive airway pressure ventilation and high-flow nasal cannula, and underwent a rapid recovery. CONCLUSION: Gadolinium-based contrast agent-induced acute respiratory distress syndrome, albeit rare, should be included in the differential diagnosis of respiratory failure shortly after magnetic resonance imaging, which is nowadays a frequent diagnostic procedure, potentially increasing the awareness of this serious complication.


Assuntos
Síndrome do Desconforto Respiratório , Insuficiência Respiratória , Feminino , Humanos , Adolescente , Gadolínio/efeitos adversos , Meios de Contraste/efeitos adversos , Síndrome do Desconforto Respiratório/induzido quimicamente , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/terapia , Respiração Artificial/métodos
18.
BMC Cardiovasc Disord ; 22(1): 487, 2022 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-36380270

RESUMO

OBJECTIVE: We aimed to assess the impact of using enhanced stent visualization (ESV) systems on contrast media volume and radiation dose in percutaneous coronary intervention (PCI), especially for patients with chronic kidney disease (CKD). BACKGROUND: Coronary heart disease (CHD) is associated with chronic kidney disease (CKD), as they share a similar pathological pathway. In addition, the iodinated contrast media used for angiography is a risk factor for contrast-associated acute kidney injury (CA-AKI), which could aggravate the progression of CKD. We hypothesized that ESV systems have the potential to reduce the use of contrast media as well as the radiation dose; however, few studies have reported the impact on contrast media with the use of ESV systems. METHODS: We retrospectively collected 124 patients with acute coronary syndrome who underwent PCI from May 2020 to July 2021. The patients were divided into the ESV-guided group (n = 64) and angiography-guided group (n = 60). Procedural parameters, including contrast media volume, radiation exposure (in Air Kerma-AK and Dose Area Product-DAP), number of cines, cine frames, fluoroscopy and procedure time, were recorded and analysed. RESULTS: The groups were comparable regarding the patient characteristics. There was a significant reduction in contrast media volume (174.7 ± 29.6 ml vs.132.6 ± 22.3 ml, p = 0.0001), radiation exposure (776 (499 - 1200) mGy vs. 1065 (791 - 1603) mGy, p = 0.002 in AK; 43 (37 - 73) Gycm2 vs. 80 (64 - 133) Gycm2, p = 0.030 in DAP) and procedure time (53.06 ± 21.20 min vs. 72.00 ± 30.55 min, p = 0.01) with the use of ESV systems. Similar results were observed in the subgroup analysis for the patients with CKD. CONCLUSION: This study suggested that the use of ESV is associated with reduced contrast media usage, radiation dose and procedure time during PCI. The same results were observed in a subgroup analysis in patients with CKD, and this shows that ESV-guided PCI has the potential to reduce renal impairment and mitigate the progression of CKD for those CHD patients with CKD.


Assuntos
Intervenção Coronária Percutânea , Exposição à Radiação , Insuficiência Renal Crônica , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Meios de Contraste/efeitos adversos , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Estudos Retrospectivos , Doses de Radiação , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Fatores de Risco , Stents
20.
Sci Rep ; 12(1): 19464, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376542

RESUMO

Clinically overt contrast-induced nephropathy (CIN) is one of the most feared complications in patients exposed to iodinated contrast media and has been extensively studied over the years. Meanwhile, the incidence and evolution of subclinical contrast-induced kidney injury remain elusive. With the continuous increase in the number of patients that are repeatedly exposed to contrast media, elucidating these issues is of critical importance. Accordingly, we aimed to evaluate the incidence and the evolution of clinical and subclinical kidney injury in patients exposed to contrast media. A total of 178 patients who underwent elective percutaneous angioplasty procedures were evaluated prospectively. Serum creatinine and neutrophil gelatinase-associated lipocalin (NGAL) levels were evaluated pre-procedurally, 48 h and 1 month after administration of contrast media. The evolution of creatinine and NGAL levels was analyzed at the three time points, and the potential predictors of contrast-induced clinical and subclinical renal injury were evaluated. Clinically overt CIN occurred in 10 (5.6%) patients. Baseline serum creatinine and the volume of contrast media were the only independent predictors of CIN and in all 10 patients creatinine levels returned to baseline by 1 month (p = 0.32). Subclinical contrast-induced kidney injury was much more common, affecting 32 (17.9%) patients, was only predicted by the baseline serum creatinine, and persisted in 53.1% of patients after 1 month. This study showed that whereas clinically overt CIN is rather rare and regressive, subclinical contrast-induced kidney injury is considerably more frequent, affecting almost 18% of patients that receive intraarterial contrast media. More importantly, subclinical kidney injury persisted after 1 month in more than 50% of the initially affected patients, who may thus be at increased risk for further renal impairment, particularly if exposed to nephrotoxic agents or repeated administration of contrast media.


Assuntos
Injúria Renal Aguda , Meios de Contraste , Humanos , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Biomarcadores , Meios de Contraste/efeitos adversos , Creatinina , Rim , Lipocalina-2
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