SPC365

CONTRAST-INDUCED NEPHROPATHY AFTER STAGED BALLOON PULMONARY ANGIOPLASTY: LOWER RISK COMPARED WITH PERCUTANEOUS CORONARY INTERVENTION

Session: CO 17 - Interventional Cardiology-TEP
Speaker: Ana Rita Pereira

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.4 Interventional Cardiology - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Rita F. Pereira; Rita Calé; Filipa Ferreira; Sofia Alegria; Daniel Sebaiti; Mariana Martinho; Débora Repolho; Pedro Santos; Sílvia Vitorino; Maria José Loureiro; Hélder Pereira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><strong><span style="font-family:Calibri">Introduction:</span></strong><span style="font-family:Calibri"> The risk of contrast-induced nephropathy (CIN) after left-sided cardiac procedures&nbsp;is reported as 10-15%. When the ratio of total contrast volume in ml to glomerular filtration rate (GFR) in mL/min (ratio V/GFR) exceeds 3.7 in percutaneous coronary intervention, the risk increases significantly. However, there are few reports regarding the risk of CIN in patients (pts) with right-sided cardiac interventions such as balloon pulmonary angioplasty (BPA) and ratio V/GFR is not validated for use in this procedures.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><strong><span style="font-family:Calibri">Purpose:</span></strong><span style="font-family:Calibri"> To assess the prevalence of CIN in pts with chronic thromboembolic pulmonary disease with or without hypertension (CTEPH/CTED) undergoing BPA.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><strong><span style="font-family:Calibri">Methods:</span></strong><span style="font-family:Calibri"> Prospective single-centre study that included all BPA sessions performed from 2017 to 2020. Serum creatinine concentration (SC) was measured and the GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI)&nbsp;before and 48 hours after each BPA procedure and 6 months after BPA treatment completion. CIN was defined as an increase of at least&nbsp;</span><span style="font-family:Calibri">25% and/or&nbsp;</span><span style="font-family:Calibri">0.5 mg/dL in SC </span><span style="font-family:Calibri">from the baseline value within 48h of contrast administration.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><strong><span style="font-family:Calibri">Results:</span></strong><span style="font-family:Calibri"> 76 consecutive BPA sessions were performed in 15 CTEPH/CTED pts: mean age 63.2</span><span style="font-family:Symbol">&plusmn;</span><span style="font-family:Calibri">14.0 years, 60% female, 86.7% CTEPH, </span><span style="font-family:Calibri">mean of 5.3<span style="color:black">&plusmn;1.9</span> sessions per patient with 4.3</span><span style="font-family:Symbol">&plusmn;</span><span style="font-family:Calibri">1.9 vessels dilated per session. Mean value of GFR before BPA program was 73.5</span><span style="font-family:Symbol">&plusmn;</span><span style="font-family:Calibri">26.3 mL/min. </span><span style="background-color:white; font-family:&quot;Times New Roman&quot;"><span style="font-family:Calibri"><span style="color:black">All the procedures were performed using low-osmolality contrast agent with a 1:1 dilution ratio with normal saline solution.</span></span></span> <span style="font-family:Calibri">Pts received 273.0</span><span style="font-family:Symbol">&plusmn;</span><span style="font-family:Calibri">73.0 mL of contrast per session with a ratio V/GFR 3.7</span><span style="font-family:Symbol">&plusmn;</span><span style="font-family:Calibri">1.7 mL. SC and GFR did not change significantly within 48h after BPA (+3.1%, p=0.07 and -3.0%, p=0.13, respectively). Ratio V/GFR &gt; 3.7 occurred in 44.3% of cases, but CIN occurred in only 5.3% with an increase in SC &lt;0.5 mg/dL but </span><span style="font-family:Symbol">at least&nbsp;</span><span style="font-family:Calibri">25% in 3 cases (+33% in mean) and </span><span style="font-family:Symbol">&gt;</span><span style="font-family:Calibri">0.5 mg/dL in 1 case. None of the pts required renal replacement therapy. </span><span style="font-family:Calibri">Higher SC and lower GFR 48h after BPA were significantly correlated with greater </span><span style="font-family:Calibri">ratio V/GFR </span><span style="font-family:Calibri">during procedure (r=0.75, p&lt;0.01 and r=-0.74, p&lt;0.01, respectively) &ndash; see figure.</span> <span style="font-family:Calibri">But neither higher values of ratio V/GFR (OR 1.43; CI95% 0.84-2.41; p=0.19) nor V/GFR &gt; 3.7 (OR 1.28; CI95% 0.17-9.6; p=0.81) predicted&nbsp;CIN.&nbsp;</span><span style="font-family:Calibri">GFR before procedure did not influence the contrast volume administered (p=0.901) and the number of vessels (p=0.63)&nbsp;treated by session (p=0.45).</span> <span style="font-family:Calibri">At 6 months follow-up, there was a trend for SC (</span><span style="font-family:Calibri">-15%, p=0.43) and GFR (</span><span style="font-family:Calibri">+16%, p=0.34) improvement in pts with impaired renal function at baseline </span><span style="font-family:Calibri">(GFR&lt;60 mL/min)</span><span style="font-family:Calibri">.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><strong><span style="font-family:Calibri">Conclusions: </span></strong><span style="font-family:Calibri">These findings suggested that the occurrence of CIN after BPA was low, raising the hypothesis that the influence of contrast agent on renal function could differ between left- and right-sided cardiac interventions. Although the ratio V/GFR may be correlated with the risk of nephropathy, it is necessary to find a new cut-off to predict CIN in BPA pts.</span></span></span></p>