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Cardiorenal Medicine
Journal Prestige (SJR): 0.8

Citation Impact (citeScore): 2
Number of Followers: 1

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ISSN (Print) 1664-3828 - ISSN (Online) 1664-5502
Published by Karger

[120 journals]

Point of Care Ultrasonography for Objective Assessment of Heart Failure:
Integration of Cardiac, Vascular, and Extravascular Determinants of Volume
Status
- Abstract: Background: Lingering congestion portends poor outcomes in patients with heart failure (HF) and is a key target in their management. Studies have shown that physical exam has low yield in this setting and conventional methods for more precise assessment and monitoring of volume status (e.g., body weight, natriuretic peptides, and chest radiography) have significant inherent shortcomings. Summary: Point of care ultrasonography (POCUS) is a noninvasive versatile bedside diagnostic tool that enhances the sensitivity of conventional physical examination to gauge congestion in these patients. It also aids in monitoring the efficacy of decongestive therapy and bears prognostic significance. In this narrative review, we discuss the role of focused sonographic assessment of the heart, venous system, and extravascular lung water/ascites (i.e., the pump, pipes, and the leaks) in objective assessment of fluid volume status. Key Messages: Since each of the discussed components of POCUS has its limitations, a combinational ultrasound evaluation guided by the main clinical features would be the key to reliable assessment and effective management of congestion in patients with HF.
  Cardiorenal Med
  PubDate: Thu, 21 Jan 2021 15:28:05 +010
Dynamic Changes in Portal Vein Flow during Decongestion in Patients with
Heart Failure and Cardio-Renal Syndrome: A POCUS Case Series
- Abstract: Introduction: Optimal method for noninvasive assessment of venous congestion remains an unresolved issue. Portal vein (PV) and intrarenal venous flow alterations are markers of abdominal venous congestion and have been associated with acute kidney injury (AKI) in cardiac surgery patients. It is currently unknown if portal vein flow (PVF) alterations in heart failure can be reversed with diuretic treatment and track decongestion. Objective: The aim of this study is to evaluate PVF alterations in patients with ADHF at arrival and after decongestive treatment. Methods: Assessment of venous congestion using point-of-care ultrasound was performed in 12 patients with ADHF (6 patients with left-sided heart failure and 6 patients with right-sided heart failure). Evaluation included inferior vena cava (IVC) size and collapsibility in addition to PV Doppler to determine pulsatility fraction (PF). Results: Increased PV PF (81.75 ± 13%) was found on admission. After effective decongestive treatment, it improved to (17.43 ± 2.2%). Improvement in IVC size and collapsibility was seen in most patients with left-sided heart failure and none of the patients with right-sided heart failure. Improvement in PV PF coincided with return to baseline of Serum Cr in patients that presented with AKI. Conclusions: Evaluation of abdominal venous congestion by point-of-care ultrasound could aid in diagnosis and follow-up of patients with congestive kidney injury.
  Cardiorenal Med
  PubDate: Thu, 21 Jan 2021 07:45:05 +010
Resurgence of Urgent-Start Peritoneal Dialysis in COVID-19 and Its
Application to Advanced Heart Failure
- Abstract:
  Cardiorenal Med
  PubDate: Thu, 07 Jan 2021 11:54:03 +010
Prediction of All-Cause Mortality Using an Echocardiography-Based Risk
Score in Hemodialysis Patients
- Abstract: Aim: To derive an echocardiography-based prognostic score for a 3-year risk of mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Methods: 173 ESRD patients hospitalized in the second affiliated hospital of Soochow University from January 1, 2010, to July 31, 2016, were enrolled and followed up for 3 years. All subjects began to receive HD from recruitment. Baseline clinical and echocardiographic parameters were collected and screened for risk factors using univariate and multivariate analysis. The prognostic value of echocardiographic indexes was determined by concordance indexes and reclassification assay. Restricted cubic spline models (RCS) and forest plots were employed to visualize the association between risk factors and all-cause mortality. A multivariate nomogram including the identified factors was developed to estimate the prognosis. Results: After multivariate adjustment for advanced age, hypertension, diabetes, and decreased hemoglobin (Hb), echocardiographic indexes including left atrial diameter index (LADI), cardiac valvular calcification, and moderate to severe cardiac valve regurgitation were independently associated with the risk of 3-year mortality in HD patients. RCS showed that age, Hb, and LADI were positively associated with the risk of mortality. Adding multiple echocardiographic indexes to a basic model containing age, hypertension, diabetes, and Hb increased the concordance index and improved reclassification. A multivariate Cox model-derived nomogram showed the association between each factor and mortality by the end of follow-up. Conclusions: Echocardiographic indexes showed independent predictive power for mortality in ESRD patients and may constitute a promising prognostic tool in this population.
  Cardiorenal Med
  PubDate: Thu, 17 Dec 2020 08:21:51 +010
Prognostic Value of Estimated Glomerular Filtration Rate 3–6 Months
after Percutaneous Coronary Intervention
- Abstract: Background: The prognostic significance of follow-up (f/u) renal function for patients undergoing percutaneous coronary intervention (PCI) remains unknown. This study sought to investigate the prognostic implications of f/u renal function in patients undergoing PCI. Methods: A drug-eluting stent registry was used. We divided patients into 4 groups according to the change in the estimated glomerular filtration rate (eGFR) before PCI and 3–6 months after PCI. Patients with normal pre-PCI eGFR and f/u eGFR were assigned to group 1. Those with normal pre-PCI eGFR and abnormal f/u eGFR were assigned to group 2. Patients with abnormal pre-PCI eGFR and normal f/u eGFR were assigned to group 3. Patients with abnormal pre-PCI eGFR and f/u eGFR were allocated into group 4. Results: A total of 4,899 PCI patients were enrolled. The death rate in group 1, 2, 3, and 4 at 3 years was 2, 11, 4, and 9%, respectively. This showed significant differences between groups, except between groups 2 and 4. The prognosis of a group with aggravation from normal renal function was worse than that of a group with recovery from abnormal renal function. A prediction model that combines clinical risk factors and f/u eGFR has more power for predicting clinical outcomes than a combination of clinical risk factors and pre-PCI eGFR. Conclusion: Post-PCI eGFR was more accurate for predicting patient outcomes than pre-PCI eGFR.
  Cardiorenal Med
  PubDate: Thu, 17 Dec 2020 08:21:15 +010
Effect of Cryptotanshinone on Measures of Rat Cardiomyocyte Oxidative
Stress and Gene Activation Associated with Apoptosis
- Abstract: Background: Oxidative stress is a key factor that results in cardiomyocyte apoptosis and cardiovascular diseases. Cryptotanshinone (CTS), one of the major bioactive constitutes extracted from the root of the plant Salvia miltiorrhizaBunge, has been widely studied for various disease treatments. However, the roles of CTS on cardiomyocytes remain unclear. Methods: In the present study, neonatal rat cardiomyocytes were pretreated with CTS for 4 h before being exposed to H2O2. Cell viability for the cells with or without pretreatment with CTS before exposure to H2O2 was evaluated by the MTT assay. Production of lactate dehydrogenase (LDH), nitric oxide (NO), prostaglandin E2 (PGE2), malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxides (GSH-Px) was quantified by corresponding detection kits. The mRNA levels of Bcl-2 antiapoptotic and Bax-like proapoptotic genes were quantified with RT-PCR. Production of reactive oxygen species (ROS) was qualified and quantified with a dichlorofluorescein diacetate cellular ROS detection assay kit. The extracellular signal-related kinase (ERK) phosphorylation and nuclear factor κB (NF-κB) activation were measured by Western blot. Results: Our results revealed that the CTS pretreatment could enhance cell viability and promote Bcl-2 antiapoptotic gene expression. Additionally, CTS could abolish the H2O2-induced production of NO, LDH, and PGE2. Consistent with these findings, CTS could inhibit ROS and MDA production and promote SOD, CAT, and GSH-Px activities. Mechanistically, CTS may achieve these processes by inhibiting ERK and NF-κB signal pathways. Conclusion: CTS protects cardiomyocytes against the H2O2-induced cellular injuries through ERK and NF-κB inactivation and ROS scavenging. Therefore, CTS is a promising reagent against ROS-induced cardiomyopathy.
  Cardiorenal Med
  PubDate: Wed, 16 Dec 2020 09:45:00 +010
Coronary Computed Tomography Angiography in Diagnosing Obstructive
Coronary Artery Disease in Patients with Advanced Chronic Kidney Disease:
A Systematic Review and Meta-Analysis
- Abstract: Introduction: Coronary computed tomography angiography (CCTA) is emerging as an important noninvasive testing modality for coronary angiography. The performance characteristic of CCTA in patients with advanced kidney disease is unknown. Methods: We performed a systematic review and meta-analysis of studies specifically investigating the sensitivity and specificity of CCTA compared to coronary angiogram as a reference standard in patients with advanced kidney disease, defined as dialysis dependence or nearing kidney transplantation. Two independent investigators assessed studies for inclusion/exclusion, quality, and characteristics, while a third investigator adjudicated. Results: We identified 4 studies including a total of 217 patients, of whom 159 were dialysis dependent. Three of the 4 studies had a high risk of bias in patient selection and study flow, while 1 study rated low in all areas of bias. The studies were heterogeneous in their patient selection and CCTA protocol but consistent in their definition of obstructive coronary artery disease. The pooled sensitivity and specificity for CCTA were 0.96 (0.87–0.99) and 0.66 (0.57–0.74), respectively. When we restricted the analysis to dialysis-dependent patients, the pooled sensitivity and specificity for CCTA were 0.99 (0.74–1.00) and 0.67 (0.49–0.82), respectively. Conclusions: Based on limited data, CCTA appears to have comparable sensitivity but lower specificity relative to the non-kidney disease population.
  Cardiorenal Med
  PubDate: Tue, 15 Dec 2020 12:35:17 +010
Renal Dysfunction following Direct Current Cardioversion of Atrial
Fibrillation: Incidence and Risk Factors
- Abstract: Introduction: Emerging data suggest that cardioversion for atrial fibrillation (AF) may be associated with acute kidney injury (AKI). However, limited data are available regarding the incidence and risk factors for AKI after direct current cardioversion (DCCV) of AF. Methods: All patients undergoing DCCV at Mayo Clinic between 2001 and 2012 for AF were prospectively enrolled in a database. All patients with serum creatinine (SCR) values pre- and post-cardioversion were reviewed for AKI, defined as a ≥25% decline in eGFR (estimated glomerular filtration rate) from baseline value within 7 days of the DCCV. Results: Of the 6,427 eligible patients, 1,256 (19.5%) patients had pre- and post-DCCV SCR available and formed the cohort under study. The mean age was 70.4 (SD 11.7) years, and 67.3% were male. During the study period, 131 (10.4%) patients suffered from AKI following DCCV. AKI was independently associated with inpatient status (OR 26.79; 95% CI 3.69–194.52), CHA2DS2-VASc score (OR 1.25; 95% CI 1.11–1.41), prior use of diuretics (OR 1.59; 95% CI 1.03–2.46), and absence of CKD (OR 1.61; 95% CI 1.04–2.49), and was independent of the success of the DCCV. None of the patients required acute dialysis during the study outcome period. Conclusion: AKI following DCCV of AF is common, self-limited, and without the need for replacement therapies.
  Cardiorenal Med
  PubDate: Wed, 09 Dec 2020 11:10:16 +010
Contents Vol. 10, 2020
- Abstract:
  Cardiorenal Med 2020;10:I–VI
  PubDate: Fri, 04 Dec 2020 07:54:24 +010
Acknowlegement to Reviewers
- Abstract:
  Cardiorenal Med 2020;10:476–477
  PubDate: Fri, 04 Dec 2020 07:54:08 +010