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Contrast-induced acute kidney injury after cardiac resynchronization therapy implant impairs the recovery of ejection fraction in responder patients

Session Poster session 1

Speaker Teresa Strisciuglio

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Poster Session
  • FP Number : P555

Authors : T Strisciuglio (Naples,IT), G Ammirati (Naples,IT), V Pergola (Naples,IT), L Imparato (Naples,IT), C Carella (Naples,IT), E Koci (Naples,IT), R Chiappetti (Naples,IT), FG Abbate (Naples,IT), VM La Fazia (Naples,IT), B Trimarco (Naples,IT), A Rapacciuolo (Naples,IT)

T Strisciuglio1 , G Ammirati1 , V Pergola1 , L Imparato1 , C Carella1 , E Koci1 , R Chiappetti1 , FG Abbate1 , VM La Fazia1 , B Trimarco1 , A Rapacciuolo1 , 1Federico II University of Naples, Department of Advanced Biomedical Sciences - Naples - Italy ,


Background Contrast medium may induce nephropathy in at-risk patients undergoing invasive procedures. Data regarding contrast induced acute kidney injury (AKI) after cardiac resynchronization therapy defibrillator (CRTD) implant are limited.
Purpose To investigate the incidence of AKI after CRTD implantation, its determinants and the outcomes.
Methods We retrospectively analysed patients undergoing CRTD implant. Renal function was evaluated at baseline and within 48 hours after the implant. AKI was defined as an increase of serum creatinine =0,3mg/dl  or = 50% of the baseline value. Echocardiography and follow-up visits were scheduled for each patient at 3 and 12 months. Response to CRTD was defined as a reduction of left ventricle end-systolic volume (LVESV) of 15% or the increase of 5 percentage points in ejection fraction(EF). 
Results Overall 107 patients were included. Patients at baseline had a mild impaired renal function (eGFR 65±30 ml). 
AKI occurred in 13 patients (12%). None of the baseline clinical, echocardiographic and laboratory characteristics were associated with the occurrence of AKI. At 3 months there were no significant differences between patients with or without AKI in symptoms’ improvement, EF and LVESV(Table 1). Of note, in the responders group, while EF at baseline was not different between patients with or without AKI, conversely at 3 months AKI patients had a significantly lower EF (28,5% vs 35,7% p= 0,003; figure 1). 
At a median follow-up of 112 week 38/88 (43%) patients experienced a clinical event, with no significant difference in the incidence between AKI and non-AKI patients.
Conclusions The incidence of AKI in patients undergoing CRTD implantation is rather high. AKI doesn’t influence response to CRTD overall, but amongst responders impairs the recovery of ejection fraction. At follow up AKI doesn’t impact the prognosis.

No AKI AKI P value
Responders, (%) 28/53(53) 8/10(80) 0,2
NYHA III/IV, (%) 84/93(90) 11/12(92) 0,7
NYHA III/IV post, (%) 26/66(39) 5/11(45) 0,6
EF, % 28±7 26±7 0,2
EF post, % 31±8 28±5 0,3
LVESV, ml 130±57 136±36 0,7
LVESV post, ml 110±47 114±21 0,8
NYHA III-IV is New York Heart Association class III-IV; EF is ejection fraction; LVESV is left ventricle end-systolic volume; NYHA III/IV post, EF post, LVSEV post means at 3 months follow-up.

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