Efficacy of Oral Nicorandil to Prevent Contrast-Induced Nephropathy in Patients with Chronic Renal Dysfunction Undergoing an Elective Coronary Procedure

Objectives: This prospective, randomized study was to investigate the role of nicorandil in the prevention of contrast-induced nephropathy (CIN) in patients with chronic renal dysfunction undergoing an elective coronary procedure. Methods: A total of 252 eligible patients were enrolled in this study and allocated into the control group (n = 125) or nicorandil group (n = 127). Both groups received the standard hydration treatment, and patients in the nicorandil group were orally administrated 10 mg of nicorandil (t.i.d.) beginning 2 days before and continuing for 2 days after an elective coronary procedure. Serum creatinine (SCr) and cystatin C (CysC) were measured at 24 h before and 24, 48, and 72 h after the procedure. The occurrences of CIN and adverse events within 1 year were recorded. Results: The nicorandil group had relatively lower SCr and CysC levels and a higher eGFR at 24 and 48 h after the procedure than the control group (p < 0.05). The incidence of CIN was significantly decreased in the nicorandil group compared to the control group. The multivariate logistic regression model revealed that nicorandil treatment was an independent protective factor for CIN (OR 0.669, 95% CI 0.522–0.857, p = 0.001). The multivariate COX proportional hazard model showed that nicorandil treatment was an independent protective predictor for adverse events (HR 0.881, 95% CI 0.781–0.993, p = 0.037). Conclusions: Nicorandil could exhibit a protective effect against CIN in patients with chronic renal dysfunction undergoing an elective coronary procedure and reduce the adverse events within 1 year after the procedure, which is superior to hydration treatment only.

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Preventive Effects of Nicorandil Against Contrast-Induced Nephropathy in Patients With Moderate Renal Insufficiency Undergoing Percutaneous Coronary Intervention

Angiology ◽

10.1177/0003319719841733 ◽

2019 ◽

Vol 71 (2) ◽

pp. 183-188 ◽

Cited By ~ 4

Author(s):

Peng Zhang ◽

Wen-yuan Li ◽

Shi-Cheng Yang ◽

Nai-Kuan Fu ◽

Xiao-Gang Liu ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Adverse Events ◽

Renal Insufficiency ◽

Protective Factor ◽

Coronary Intervention ◽

Control Group ◽

Contrast Induced Nephropathy ◽

Percutaneous Coronary ◽

Major Adverse Events ◽

Moderate Renal Insufficiency

We investigated the preventive effect of nicorandil on contrast-induced nephropathy (CIN) in patients with moderate renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 250 patients with a creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to either a nicorandil group (nicorandil 10 mg 3 times/d and hydration; n = 125) or a control group (hydration only; n = 125). The first end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or ≥25% within 72 hours after exposure to the contrast medium. The secondary end points were (1) changes in Scr, blood urea nitrogen, and crCl and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 1.6% (2/125) in the nicorandil group and 9.6% (12/125) in the control group ( P = .011). There was no obvious difference in the incidence of major adverse events during hospitalization between the nicorandil and the control group (4.0% vs 4.8%, P = 1.000). Multivariate logistic regression analysis showed that nicorandil was a protective factor for CIN (odds ratios = 0.126, 95% confidence interval: −19.996 to −0.932, P = .012). Prophylactic administration of nicorandil may prevent against CIN in patients with moderate renal insufficiency undergoing PCI.

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Renal arteries denervation with second generation systems: a remedy for resistant hypertension?

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa158 ◽

2020 ◽

Vol 22 (Supplement_L) ◽

pp. L160-L165

Author(s):

Francesco Versaci ◽

Sebastiano Sciarretta ◽

Massimiliano Scappaticci ◽

Simone Calcagno ◽

Riccardo di Pietro ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Second Generation ◽

Randomized Study ◽

Renal Arteries ◽

Control Group ◽

Energy Delivery ◽

Arterial Blood ◽

Treatment Of Hypertension ◽

Effective Therapeutic Strategy

Abstract Initial studies on renal denervation (RDN) for the treatment of non-controlled arterial hypertension (HTN) through radiofrequency ablation of renal arteries demonstrated that RDN is an effective therapeutic strategy to reduce arterial blood pressure (BP). Nonetheless, the first randomized study, SYMPLICITY-HTN-3, failed to demonstrate a clear benefit for RND over the control group. Technologic evolution, with the introduction of new second generation multi-electrode devices, allowed deep energy delivery along the full circumference of the vessel. Two recent randomized studies involving patients assuming (SPYRAL HTN-ON MED) or not (SPYRAL HTN-OFF MED) antihypertensive pharmacologic treatment, demonstrated the efficacy and safety of RDN using second generation systems for radiofrequency ablation. Another recent randomized study demonstrated that RDN with ultrasounds (RADIANCE-HTN SOLO) of the main renal arteries led to a significant BP reduction compared to the control group. These studies have once again raised the interest of the scientific community towards attempting to define the appropriate role of RDN in the treatment of hypertension. Nonetheless, larger and longer clinical trials will be necessary to draw further conclusions.

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HLA loci predisposing to immune TTP in Japanese: potential role of the shared ADAMTS13 peptide bound to different HLA-DR

Blood ◽

10.1182/blood.2020005395 ◽

2020 ◽

Vol 135 (26) ◽

pp. 2413-2419 ◽

Cited By ~ 2

Author(s):

Kazuya Sakai ◽

Masataka Kuwana ◽

Hidenori Tanaka ◽

Kazuyoshi Hosomichi ◽

Atsushi Hasegawa ◽

...

Keyword(s):

Protective Factors ◽

Protective Factor ◽

Autoimmune Disorder ◽

Japanese Patients ◽

Control Group ◽

Predisposing Factor ◽

Binding Motifs ◽

Hla Dr ◽

Immune Mediated

Abstract Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare autoimmune disorder caused by neutralizing anti-ADAMTS13 autoantibodies. In white individuals, HLA allele DRB1*11 is a predisposing factor for iTTP, whereas DRB1*04 is a protective factor. However, the role of HLA in Asians is unclear. In this study, we analyzed 10 HLA loci using next-generation sequencing in 52 Japanese patients with iTTP, and the allele frequency in the iTTP group was compared with that in a Japanese control group. We identified the following HLA alleles as predisposing factors for iTTP in the Japanese population: DRB1*08:03 (odds ratio [OR], 3.06; corrected P [Pc] = .005), DRB3/4/5*blank (OR, 2.3; Pc = .007), DQA1*01:03 (OR, 2.25; Pc = .006), and DQB1*06:01 (OR,: 2.41; Pc = .003). The estimated haplotype consisting of these 4 alleles was significantly more frequent in the iTTP group than in the control group (30.8% vs 6.0%; Pc < .001). DRB1*15:01 and DRB5*01:01 were weak protective factors for iTTP (OR, 0.23; Pc = .076; and OR, 0.23, Pc = .034, respectively). On the other hand, DRB1*11 and DRB1*04 were not associated with iTTP in the Japanese. These findings indicated that predisposing and protective factors for iTTP differ between Japanese and white individuals. HLA-DR molecules encoded by DRB1*08:03 and DRB1*11:01 have different peptide-binding motifs, but interestingly, bound to the shared ADAMTS13 peptide in an in silico prediction model.

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Role of hyperoxygenation on surgical site wound infection: a randomised case control study

International Surgery Journal ◽

10.18203/2349-2902.isj20193344 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2927

Author(s):

Samba Siva Rao G. ◽

Kiran Kumar Suggala

Keyword(s):

Surgical Site Infection ◽

Case Control Study ◽

Elective Surgery ◽

Randomized Study ◽

Control Group ◽

Site Infection ◽

Medical College ◽

Induction Of Anaesthesia ◽

Control Study

Background: The aim of this study was to assess the influence of hyperoxygenation on surgical site wound infections.Methods: Using prospective randomized study, conducted from January 2018 to December 2018 at Mamata Medical College and General hospital, Khammam. This study includes 100 patients who were going for elective surgery at various divisions of Department of surgery. Patients were assigned randomly to an oxygen/air mixture with a faction of inspiration (FiO2) of 30% (n=50) and 60% (n=50). Administration was started after induction of anaesthesia and maintained for 3hours after surgery.Results: Surgical site infection was recorded in 5 patients (2 of 50, 10%) in the hyperoxygenation group and 11 patients (11 of 50, 22%) in the control group (p<0.05). Time of hospitalization was 5±3 days in the hyperoxygenation group and 9±4 days in the control group (p<0.05).Conclusions: Hyperoxygenation was associated with a reduction in surgical site infection. It also decreases the duration of hospital stay and decreases economic burden.

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Role of Colchicine in Prevention of Contrast Induced Nephropathy in Patient Undergoing Primary Percutaneous Coronary Intervention

QJM ◽

10.1093/qjmed/hcab090.032 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Omar M Elhodhod ◽

Mohamed M Farouk ◽

Hazem M Khorshed Walid A ◽

. El Hammady

Keyword(s):

Relative Risk Reduction ◽

Coronary Intervention ◽

Control Group ◽

Primary Pci ◽

Contrast Induced Nephropathy ◽

Standard Guideline ◽

Percutaneous Coronary ◽

Anti Oxidant ◽

Contrast Media Administration

Abstract Background Contrast-induced nephropathy (CIN) is a frequent complication after intravascular contrast media administration. The incidence of CIN in STEMI patients undergoing primary PCI is around 19.8%. The pathophysiologic basis of CIN includes an oxidative stress and inflammatory process, and colchicine has been used as an anti-inflammatory and anti-oxidant agent to improve cardiovascular outcomes, hence the aim of the current study is to demonstrate the effect of colchicine on CIN in patients undergoing primary PCI. Patients and methods 100 STEMI patients planned for primary PCI were enrolled in this study. They were randomized into two groups of fifty patients: A control group receiving standard guideline based medical treatment alone and a study group receiving same treatment in addition to colchicine. CIN was defined based on serum creatinine that was measured repeatedly over 3 days, with absolute rise of 0.5mg/dl or relative rise of 25% or more from baseline signifying CIN. Results There was a trend towards lower CIN incidence, although not statistically significant, in patients receiving colchicine, in whom CIN incidence was 8%, in comparison to incidence of 20 in those receiving standard guideline-based therapy alone % (χ2 = 2.99 & p = 0.083) with relative risk reduction of 60%. The reduction of CIN incidence was found to be statistically significant in diabetic subgroup, with CIN incidence of 32% in those receiving standard guideline-based therapy alone, in comparison to incidence of 7% in those receiving colchicine with p = 0.033. Multiple regression analysis including colchicine as a covariable concluded that colchicine use was the most important CIN risk lowering factor in the current study (β = -0.223 and p = 0.039). Conclusion There was a trend towards lower incidence of CIN in patients undergoing primary PCI receiving colchicine, although not statistically significant. However, this trend became significant when studied in diabetic subgroup.

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Effect of Levosimendan on the Prognosis of Cardiac Surgery in Patients with Cardiac Insufficiency

10.21203/rs.3.rs-92126/v1 ◽

2020 ◽

Author(s):

Heya Na ◽

Xianen Fa ◽

Yuyang Zhou ◽

Xiangyang Li ◽

Rui Zhu ◽

...

Keyword(s):

Cardiac Surgery ◽

Hospital Stay ◽

Protective Factor ◽

Propensity Score Analysis ◽

Cardiac Insufficiency ◽

Multivariate Logistic Regression Model ◽

Control Group ◽

Low Cardiac Output Syndrome ◽

Routine Treatment ◽

Score Analysis

Abstract Objective: To retrospectively analyze the effect of levosimendan on the survival and prognosis of cardiac surgery patients with LVEF < 40%. Methods: the clinical data of 224 patients with preoperative LVEF < 40% were retrospectively analyzed. According to different treatment schemes, the patients were divided into levosimendan group (n = 60) and no-levosimendan group (n = 164,). The control group was treated with routine treatment, and the observation group was treated with levosimendan on the basis of routine treatment. Then a multivariate logistic regression model with a propensity score analysis was used to limit biases and finally the data of 40 patients in each group were selected for analysis. Results: Hemodynamic data showed that the cardiac index, LVEF and PAOP of patients in levosimendan group were significantly improved. The concentration of serum lactic acid in the levosimendan group was lower than that in the control group (P < 0.05). At the same time, postoperative ICU and hospital stay were significantly reduced in levosimendan group (P < 0.05.), Logistics regression analysis showed that levosimendan was the only protective factor for Low cardiac output syndrome (LCOS) (HR=4.33; 95% confidence interval: 1.27- 14.78; P = 0.019). Conclusion: levosimendan can better improve hemodynamics and reduce postoperative ICU time and hospital stay. The use of it tended to decrease the incidence of LCOS significantly.

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Insights from cardiopulmonary exercise testing in pediatric patients with hypertrophic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehab724.1768 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

G Gallo ◽

V Mastromarino ◽

G Limongelli ◽

G Calcagni ◽

L Ragno ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Adverse Events ◽

Exercise Capacity ◽

Univariate Analysis ◽

Control Group ◽

Cardiopulmonary Exercise ◽

End Point ◽

Peak Vo2

Abstract Background Hypertrophic cardiomyopathy (HCM) is characterized by extremely varied phenotypic expression ranging from asymptomatic to heart failure (HF) to sudden cardiac death (SCD). Although children with HCM are considered in the highest risk spectrum, the most common recommendations on pharmacological and non-pharmacological treatment (i.e. drugs, ICD, septal reduction procedures, inclusion in cardiac transplantation list) are often disregarded or too much postponed in this setting and strong evidence-based risk prediction models are missing. A systematic cardiopulmonary exercise test (CPET) assessment might be helpful to disclose an unsuspected functional limitation. Purpose The aim of our multicenter retrospective study was to investigate possible clinical insights, in terms of functional and prognostic assessment, coming from a full CPET assessment in a cohort of pediatric HCM outpatients aged less than 18 years old. Methods Sixty consecutive pediatric HCM outpatients aged <18 years-old were enrolled, each of them undergoing a full clinical assessment including a CPET; a group of 60 healthy subjects served as controls. An unique composite end-point of HF-related and SCD or SCD-equivalent events was also explored. During a median follow-up of 53 months, a total of 13 HF- and 7 SCD-related first events were collected. Results An impaired exercise capacity, consisting on peak VO2 values <80% of the predicted, has been found in the 78% of the study sample (n. 47 patients). Despite most of the HCM patients were classified in NYHA I functional class, most of them (n. 33, 73%) showed a reduced exercise capacity, the percentage of impaired exercise capacity raising in the NYHA II group (n. 14 patients, 93%). Respect to the control Group, the HCM patients showed a significantly poorer functional status in terms of maximum workload achieved, peak VO2 (regardless the adopted correction), circulatory power and VE/VCO2 slope values (Figure 1, panel A). HCM patients who experience adverse events during the follow-up (Event Group) showed the worst CPET profile (Figure 1, panel B). The composite end-point occurred more frequently in patients with the worst CPETs' profiles. At the univariate analysis, peak VO2% was the variable with the strongest association with adverse events at follow-up (C-index=0.72, p=0.025) and a cut-off value equal to 60% was the most accurate in identifying those patients at the highest risk (Figure 2). Conclusions Our findings support the role of CPET analysis as an insightful approach in the young HCM clinical management. In a group of young asymptomatic or slightly symptomatic HCM patients, the CPET allowed us to estimate accurately their functional capacity and to disclose a portion of un-recognized exercise impairment. Our data argue in favor of a possible role of some CPET-derived variables in the early identification of those young HCM patients at highest risk of HCM related events. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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SARS-Cov 2 infection and anti-tuberculosis immunity: temporal association or real protective role?

10.21203/rs.3.rs-1129122/v1 ◽

2021 ◽

Author(s):

HAMMI SANAA ◽

BOURKIA MYRIEM ◽

ADIL NAJDI ◽

CHAHBOUNE RAJAE ◽

RISSOUL KARIMA ◽

...

Keyword(s):

Protective Factor ◽

Protective Role ◽

Temporal Association ◽

Control Group ◽

The Face ◽

Cross Immunity ◽

And Control ◽

Rule Out ◽

Pro Inflammatory Cytokines

Abstract Introduction: According to the literature consulted to date, there is epidemiological heterogeneity of covid 19 between countries depending on their vaccination policy, in particular BCG vaccination. These findings have led to several hypotheses, including the protective role of immunity induced by the BCG tuberculosis vaccine against Covid-19 infection. The immunity induced by the BCG vaccine significantly increases the secretion of pro-inflammatory cytokines, in particular IL-1B, which has been shown to play an essential role in antiviral immunity. This cross-immunity, although not specific, if highlighted, is a real providence that must be taken advantage of in the face of this pandemic. The main objective of this study is to rule out or confirm that anti-tuberculosis immunity protects against SARS-COV 2 in our context. Materiel and methods: Two groups will be compared: cases infected with the virus and controls who have never been infected with the virus. Both case and control groups will undergo a tuberculin skin test: the intra dermal tuberculin reaction (IDR). Results: We found that our control group had a high IDR immunity value, with an IDR tuberculin positive percentage of 67.2%. This suggests that immunity to IDR is a protective factor against coronavirus disease. Conclusion: The hypothesis of nonspecific anti-tuberculosis protection deserves further verification studies; it would have large positive repercussions for developing countries.

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