Acute Kidney Injury After Percutaneous Edge-to-Edge Mitral Repair.

BACKGROUND: In catheter-based procedures, acute kidney injury (AKI) is a frequent, serious complication ranging from 10% to 30%. In MitraClip (Abbott Vascular, Santa Clara, California), a usually contrast-free procedure, there is scarce data about its real incidence and impact. OBJECTIVES: This study aimed to evaluate incidence, predictive factors, and midterm outcomes of AKI in patients with significant mitral regurgitation (MR) undergoing transcatheter valve repair with MitraClip. METHODS: A total of 721 patients undergoing MitraClip were included. AKI was defined as an absolute or a relative increase in serum creatinine of >0.3 mg/dl or ≥50%, respectively, or the need for hemodialysis during index hospitalization. RESULTS: The mean age of the patients was 72 ± 11 years (28.3% women). Median estimated glomerular filtration rate (eGFR) was 43.7 ml/min/1.73 m2 (interquartile range: 30.9 to 60.1 ml/min/1.73 m2), and was <60 ml/min/1.73 m2 in 74.9% of the patients. AKI after MitraClip occurred in 106 patients (14.7%). Baseline hemoglobin (<11 g/dl) (odds ratio [OR]: 1.97; p = 0.003), urgent procedure (OR: 3.44; p = 0.003), and absence of device success (OR: 3.37; p < 0.001) were independent predictors of AKI. Patients with AKI had worse outcomes compared to those without AKI, including a higher proportion of in-hospital bleeding events (3.8% vs. 0.8%; p = 0.011), 2-year all-cause mortality (40.5% vs. 18.7%; p <0.001), and major adverse cardiac events (63.6% vs. 23.5%; p <0.001). Combination of AKI with significant residual MR after the procedure conferred even worst outcomes (2-year all-cause mortality 50.0% vs. 19.6%; p = 0.001, and major adverse cardiac events 70.0% vs. 18.9%; p < 0.001). CONCLUSIONS: Despite being a "zero-contrast" procedure, one-sixth of patients undergoing transcatheter mitral valve repair had AKI, linked to device failure or other severe conditions. The occurrence of AKI was associated with worse outcomes, highlighting the importance to detect and reduce this complication in high-risk population.

[Dobutamine stress echocardiography and troponin T as a marker of myocardial injury]. / Ecocardiografía de estrés con dobutamina y troponina T como marcador de daño miocárdico.

Introduction and objectives. Troponin T (TnT) is a very specific marker of myocardial damage. Our objective was to describe TnT behavior after dobutamine stress echocardiography (EDOB) and evaluate its usefulness for improving the diagnostic power of EDOB.Methods. Blood levels of TnT were measured at baseline and 3, 6, 12, and 24 h after EDOB in 63 patients (mean age: 69 9; 38 males). Coronary angiography was performed on 36 patients.Results. EDOB was positive in 29 patients and there was an increase over baseline values in 15 of them (51%); EDOB was negative in 34 patients and there was only a rise in TnT in 7 (20%; p < 0.01). The TnT increment was higher in patients with a positive response to EDOB (0.033 0.02 vs. 0.026 0.01; p < 0.01). The ischemia score index was higher in patients in which a significant increase in TnT values was later detected (0.41 0.31 vs. 0.38 0.20; p < 0.01). Coronariography was performed in 36 patients. EDOB was positive in 22 of the 29 patients with coronary artery disease (76%) and TnT was raised in 14 of them (48%; p < 0.05).Conclusion. The rise in TnT levels during EDOB suggests that this test may produce myocardial damage associated with the appearance of contractility disorders during dobutamine infusion.

Ecocardiografía de estrés con dobutamina y troponina T como marcador de daño miocárdico / Dobutamine stress echocardiography and troponin T as a marker of myocardial injury

Introducción y objetivos. La troponina T (TnT) es un marcador muy específico de daño miocárdico. Nuestro objetivo fue describir el comportamiento de la TnT después de la realización de la ecocardiografía con dobutamina (EDOB) y valorar su utilidad para mejorar el poder diagnóstico de la EDOB. Métodos. Los niveles en sangre de TnT fueron obtenidos basalmente y a las 3, 6, 12 y 24 h después de hacer una EDOB en 63 pacientes (edad media: 69 ñ 9 años; 38 varones). Se realizó coronariografía en 36 de ellos. Resultados. La EDOB fue positiva en 29 pacientes y en 15 de ellos hubo un incremento de TnT respecto a los niveles basales (51 por ciento); la EDOB fue negativa en 34 pacientes y sólo en 7 se elevó la TnT (20 por ciento; p < 0,01). El incremento de los valores de TnT fue superior en pacientes con respuesta positiva a la EDOB (0,033 ñ 0,02 frente a 0,026 ñ 0,01; p < 0,01). El índice de isquemia durante la EDOB fue mayor si se detectaba posteriormente una elevación significativa de los valores de TnT (0,41 ñ 0,31 frente a 0,38 ñ 0,20; p = 0,01) durante la EDOB. Los pacientes que presentan una elevación significativa de TnT tienen mayor frecuencia de cambios en el ECG (92 frente al 34 por ciento; p < 0,01) y angina (42 frente al 9 por ciento; p < 0,01) durante la EDOB. Realizamos coronariografía en 36 pacientes. De los 29 pacientes con enfermedad coronaria hubo 22 con EDOB positivo (76 por ciento) y 14 con elevación de TnT (48 por ciento; p < 0,05).Conclusión. La elevación de la TnT durante la EDOB indica que esta prueba puede provocar daño miocárdico que se asocia a la aparición de alteraciones de la contractilidad durante la administración de dobutamina (AU)