High BNP level as risk factor for acute kidney injury and predictor of all-cause mortality in STEMI patients.

OBJECTIVES: The aim of this study was to evaluate the predictive value of brain natriuretic peptide (BNP) in the development of acute kidney injury (AKI) and 6-month all-cause mortality after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in a modest-risk population. BACKGROUND: The prognostic value of BNP has been well documented in patients with acute coronary syndrome. However, its value in development of AKI and 6-month all-cause mortality in patients with STEMI undergoing primary PCI remains unclear. METHODS: We prospectively enrolled 424 consecutive STEMI patients (mean age 53.6 ± 12.1 years) undergoing primary PCI. The population was divided into two groups: a high (n = 110) and a low (n = 314) admission BNP group according to the cut-off value (> 88.7 pg/ml) determined by ROC analysis to have the best predictive accuracy for 6-month all-cause mortality. The clinical characteristics as well as the in-hospital and 6-month outcomes of patients undergoing primary PCI were analyzed. RESULTS: Cox multivariate analysis showed that a high-admission BNP value (> 88.7 pg/ml) was an independent predictor of AKI development (odds ratio, 1.002; 95 % confidence interval, 1.000­1.003; p = 0.02) and 6-month all-cause mortality (odds ratio, 1.003; 95 % confidence interval; 1.001­1.004; p = 0.004). CONCLUSION: These results suggest that a high-admission BNP level is associated with an increased risk of AKI development and 6-month all-cause mortality in patients with STEMI undergoing primary PCI.

Value of early diethylentriamine penta-acetic acid renograms in predicting late allograft outcomes.

BACKGROUND: Tc-99m-diethylentriamine penta-acetic acid (DTPA) renal scintigraphy is useful, noninvasive diagnostic tool for the management and follow-up of the transplanted kidney. There have not been any studies of the predictive value of DTPA renal scintigraphy for short- and long-term allograft functions. Our aim was to reveal the significance of different perfusion-uptake patterns observed on Tc-99m-DTPA renal scintigraphy for long-term graft outcomes. METHODS: We retrospectively analyzed 59 renal transplanted children (30 male and 29 female). All patients were underwent DTPA on posttransplant day 7. Perfusion- and function-related parameters of DTPA (the ratio of peak perfusion counts to plateau counts [P:PL], the ratio of counts at peak perfusion to counts at peak uptake [P:U], and glomerular filtration rate [GFR] calculated using commercially available software) were studied. The mean P:PL and P:U calculated using the half-moon-shaped background region of interest. A renal time activity curve was generated for evaluate perfusion- and function-related parameters. The patterns were classified and the value of these early DTPA parameters in predicting long-term graft function was analyzed. RESULTS: The mean age of patients was 16.69 ± 4.77 years. The mean posttransplant follow-up time was 3.5 ± 0.4 years. Thirty-nine patients received living-related donor allografts and the remaining 20 were from deceased donors. Thirteen children suffered ≥ 1 acute rejection episode. Eight patients lost their grafts during follow-up. Mean GFR value at year 3 was 80.61 ± 39.03 mL/1.73 m(2) BSA/min. There was a significant difference for mean creatinine values at year 3 between recipients with normal perfusion and function and normal P:PL with decreased P:U patterns in early DTPA (P < .05). The normal P:PL with decreased P:U pattern is associated with lowest GFR value at posttransplant year 3. There was also a significant difference for mean GFR values at year 3 between recipients with normal perfusion and function and acute tubular necrosis (P < .05). Acute rejection episodes and graft loss were mostly seen in recipient with a decreased P:PL with or without decreased P:U pattern in early DTPA. The decreased P:PL with or without decreased P:U pattern may be associated with high risk of acute rejection episodes and graft loss. CONCLUSION: Posttransplant early perfusion uptake patterns observed on Tc-99m-DTPA renal scintigraphy can be used as a long-term prognostic marker of poor renal outcomes. This would permit an opportunity for early intervention.

Breast involvement with post-transplant lymphoproliferative disease in a renal transplant recipient.

Post-transplant lymphoproliferative disease (PTLD) is a life-threatening complication among 1% to 20% of all organ transplant recipients. The majority of cases, if not all, are associated with Epstein-Barr virus (EBV) infection. Herein we report a 28 year-old woman who developed EBV-related PTLD in both her breasts at 12 years after renal transplantation. The purpose of this case description was to document the imaging findings in the breast associated with PTLD.

Dilated cardiomyopathy in celiac disease: role of carnitine deficiency.

Celiac disease (CD) is an immune-mediated enteropathy in genetically susceptible persons and the disease can present with manifestations in the intestine and in organs outside the gut. An increased prevalence of CD in patients with idiopathic dilated cardiomyopathy or secondary cardiomyopathy and some other cardiac disorders has been reported. Here is described a case of dilated cardiomyopathy in a patient with CD and secondary carnitine deficiency. Dilated cardiomyopathy due to carnitine deficiency may occur in CD patients and carnitine deficiency may present not only at the time of diagnosis of CD but it may also develop during gluten-free diet, particularly in patients with fast weight gain and without carnitine supplementation.

Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both.

OBJECTIVE: To evaluate aortic function and its relation to left ventricular diastolic function in patients with hypertension, diabetes, or both, without coronary artery disease. METHODS: Study groups were composed of 27 healthy participants and 25 patients with hypertension, 24 with diabetes, and 18 with hypertension and diabetes. Coronary artery disease was excluded in all of the study participants. Aortic strain and distensibility were calculated from the aortic diameters measured by echocardiography and blood pressure obtained by sphygmomanometry. RESULTS: There were significant differences between the control and the patient groups (hypertensive, diabetic, and diabetic-hypertensive) in aortic strain (mean (SD) 18 (8)% v 11 (7)%, 9 (3)%, and 8 (3)%, respectively, p < 0.001) and distensibility (10 (5.1) v 3.1 (1.5), 5.1 (2.8), and 2 (0.9) cm2/dyn/10(3), respectively, p < 0.001). In a multivariate analysis, the parameter most closely related to the deceleration time in the control group was aortic distensibility (standardised beta coefficient -0.50, p = 0.002, overall R2 = 0.25). In the patient group, the parameter most closely related to deceleration time was also aortic distensibility (standardised beta coefficient -0.36, p = 0.009, overall R2 = 0.13). Even though the study group variable was entered in to the multivariate model, aortic distensibility was found to be the parameter most closely related to deceleration time (standardised beta coefficient -0.48, p < 0.001, overall R2 = 0.22). CONCLUSION: Aortic stiffness is increased in patients with hypertension, diabetes, or both even after the exclusion of coronary artery disease. Aortic stiffness and left ventricular diastolic dysfunction are also associated in these patients.