Association between central venous pressure as assessed by echocardiography, left ventricular function and acute cardio-renal syndrome in patients with ST segment elevation myocardial infarction

BackgroundRecent reports have demonstrated the adverse effects of venous congestion on renal function in patients with heart failure. None of these trials, however, has evaluated the effect of acute myocardial ischemia on the occurrence of acute kidney injury (AKI).MethodsWe conducted a retrospective study of 1336 ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) between June 2012 and June 2016. Comprehensive echocardiographic examination was performed within 72h of hospital admission. Non-invasive evaluation of central venous pressure (CVP) was estimated from measurements of inferior vena cava diameter and its collapsibility. Intermediate-high CVP was defined as 8mm/Hg. Patients were stratified according to left ventricular ejection fraction (LVEF) and CVP and assessed for AKI.ResultsIntermediate-high CVP was associated with AKI both in patients with LVEF greater than 45% and those with 45% or lower. Patients having LVEF45% and intermediate-high CVP had a 10-fold increase in the incidence of AKI compared to patients with LVEF>45% and normal CVP (39 vs. 4%). In a multivariable logistic regression model, intermediate-high CVP was independently associated with AKI (OR=2.73, 95% CI 1.54-4.87; p=0.001). Other variables associated with AKI included LVEF45% (OR=2.37, 95%CI 1.25-4.51; p=0.008), time to reperfusion, mechanical ventilation and chronic kidney disease.ConclusionsAmong STEMI patients undergoing PCI, the utilization of simple echocardiographic measurements (LVEF and CVP) may be useful for early identification of those at high risk for AKI.