Acute Kidney Injury Increase Risk of Left Ventricular Remodeling: A Cohort of 1,573 Patients

Qiang Li; Weihua Chen; Shanshan Shi; Haozhang Huang; Wenguang Lai; Liwei Liu; Ming Ying; Bo Wang; Huanqiang Li; Zhidong Huang; Liling Chen; Jiyan Chen; Shiqun Chen; Jin Liu; Yong Liu

doi:10.3389/fphys.2021.744735

Acute Kidney Injury Increase Risk of Left Ventricular Remodeling: A Cohort of 1,573 Patients

Front Physiol. 2021 Sep 27:12:744735. doi: 10.3389/fphys.2021.744735. eCollection 2021.

Authors

Qiang Li¹, Weihua Chen², Shanshan Shi², Haozhang Huang^{1

3}, Wenguang Lai⁴, Liwei Liu^{1

3}, Ming Ying¹, Bo Wang¹, Huanqiang Li¹, Zhidong Huang¹, Liling Chen⁵, Jiyan Chen^{1

3

4}, Shiqun Chen¹, Jin Liu¹, Yong Liu^{1

3

4}

Affiliations

¹ Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
³ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁴ Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
⁵ Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.

Abstract

Background: Acute kidney injury (AKI) is a common complication after coronary angiography (CAG) and associated with heart failure (HF). Left ventricular (LV) remodeling is a vital process in the progression of HF. However, few studies investigate the relationship between AKI and LV remodeling. Methods: We included consecutive patients undergoing CAG from January 2007 to December 2018 at Guangdong Provincial People's Hospital (NCT04407936). AKI was defined as an absolute increase in serum creatinine (Scr) of ≥ 0.3mg/dl or a ≥ 50% increase in Scr from baseline within the first 48-72 h after the procedure. LV remodeling was defined as: (1) an absolute decrease in left ventricular ejection fraction (LVEF) of ≥ 10% compared to baseline, or (2) a follow-up LVEF < 40%. Univariate and multivariate logistical regressions were used to assess the association between AKI and LV remodeling. Results: Of the 1,573 patients (62.2 ± 9.7 years, female 36.7%) included in the study, 231 (14.7%) had AKI. The incidence of LV remodeling was higher in patients with AKI than in those without AKI (24.7% vs. 14.5%). After adjusting for confounding, multivariate logistic regression showed that AKI was associated with a significantly higher risk of LV remodeling [adjusted odds ratio (aOR) 1.87; 95% CI, 1.30-2.66; p < 0.001]. In addition, LV remodeling patients had higher all-cause mortality compared to non-LV remodeling patients (9.7% vs. 19.1%). Conclusion: Our data suggested that AKI is present in up to 15% of patients after CAG and that nearly a quarter of AKI patients suffered LV remodeling and AKI patients have a two-fold risk of developing LV remodeling than non-AKI patients. Our findings suggest that more active measures be taken not only to prevent AKI patient developing into LV remodeling, but to prevent patients undergoing CAG from developing AKI.

Keywords: acute kidney injury; cardiac remodeling; coronary angiography; incidence; left ventricular remodeling.