Interventional cardiologists are able to perform minimally invasive procedures, such as angioplasty and stenting, due to imaging technologies that allow them to see inside the heart and blood vessels without open surgery. Such imaging often requires injection of contrast media, which are generally safe, but for some patients with drug sensitivities or compromised kidney function, contrast-induced nephropathy (CIN) can result. CIN is a major complication that can increase in-hospital mortality. This issue of Interventional Cardiology Clinica addresses the management, treatment, and prevention of renal complications in the catheterization laboratory.

Abstract : Abstract: A low urine flow rate is a marker of acute kidney injury. However, it is unclear whether a high urine flow rate is associated with a reduced risk of contrast-induced nephropathy (CIN) in high-risk patients. We conducted this study to evaluate the predictive value of the urine flow rate for the risk of CIN following emergent percutaneous coronary intervention (PCI). We prospectively examined 308 patients undergoing emergent PCI who provided consent. The predictive value of the 24-hour postprocedural urine flow rate, adjusted by weight (UR/W, mL/kg/h) and divided into quartiles, for the risk of CIN was assessed using multivariate logistic regression analysis. The cumulative incidence of CIN was 24.4%. In particular, CIN was observed in 29.5%, 19.5%, 16.7%, and 32.0% of cases in the UR/W quartile (Q)-1 (≤0.94 mL/kg/h), Q2 (0.94–1.30 mL/kg/h), Q3 (1.30–1.71 mL/kg/h), and Q4 (≥1.71 mL/kg/h), respectively. Moreover, in-hospital death was noted in 7.7%, 3.9%, 5.1%, and 5.3% of patients in Q1, Q2, Q3, and Q4, respectively. After adjusting for potential confounding predictors, multivariate analysis indicated that compared with the moderate urine flow rate quartiles (Q2 + Q3), a high urine flow rate (Q4) (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.27–5.68; P = 0.010) and low urine flow rate (Q1) (OR, 2.23; 95% CI, 1.03–4.82; P = 0.041) were significantly associated with an increased risk of CIN. Moreover, a moderate urine flow rate (0.94–1.71 mL/kg/h) was significantly associated with a decreased risk of mortality. Our data suggest that higher and lower urine flow rates were significantly associated with an increased risk of CIN after emergent PCI, and a moderate urine flow rate (0.94–1.71 mL/kg/h) may be associated with a decreased risk of CIN with a good long-term prognosis after emergent PCI.

Acute organ damage and the ensuing multiple organ failure are the result of a pathophysiological process involving various cytokines. Once activated, these proteins cannot be eliminated even when the kidneys function at their maximum capacity. To counteract this mechanism, researchers in Japan have developed an innovative concept employing blood purification to remove the overwhelming cytokines. This book describes the use of hemodiafiltration to inhibit the cytokine storms which cause serious organ damage in patients with septic shock. Moreover, the technical construction of the blood purification system, which includes various machines, devices, membranes, fluids, etc., is explained in detail. Finally, leading experts discuss the concept of continuous renal replacement therapy as the standard care in critically ill patients with severe acute kidney injury. Describing the current state of acute blood purification, this publication provides new impulses and opens new avenues in the treatment of acute organ damage.

Coronary artery disease (CAD) and its consequences are most important morbidity and mortality reasons in the developed and developing countries. To prevent hard end-points, early definitive diagnosis and optimum therapy play significant role. Novel advanced diagnostic tests which are biomarkers of inflammation, cell adhesion, cell activation and imaging techniques provide to get the best result in the detection and characterization of calcified or uncalcified atherosclerotic plaques. In spite of last developments in the imaging methods, coronary catheterization is still frequently performed. Following the first cardiac catheterization performed in 1844, date by date historical developments and the mechanics of cardiac catheterization techniques, risks associated with coronary angiography, and also, preventions and treatments of possible complications have been presented in this book. Other important issue is radiation exposure of patients and staff during coronary angiography and scintigraphy. Radiation dose reduction techniques, general radiation protection principles have been discussed in related chapters.

Coronary artery disease (CAD) and its consequences are most important morbidity and mortality reasons in the developed and developing countries. To prevent hard end-points, early definitive diagnosis and optimum therapy play significant role. Novel advanced diagnostic tests which are biomarkers of inflammation, cell adhesion, cell activation and imaging techniques provide to get the best result in the detection and characterization of calcified or uncalcified atherosclerotic plaques. In spite of last developments in the imaging methods, coronary catheterization is still frequently performed. Following the first cardiac catheterization performed in 1844, date by date historical developments and the mechanics of cardiac catheterization techniques, risks associated with coronary angiography, and also, preventions and treatments of possible complications have been presented in this book. Other important issue is radiation exposure of patients and staff during coronary angiography and scintigraphy. Radiation dose reduction techniques, general radiation protection principles have been discussed in related chapters.

Based on documented studies, the prevalence of patients undergoing cardiac catheterization procedures developing contrast-induced nephropathy (CIN) is as many as 38% (Benson, 2008). CIN can lead to prolonged hospital stay, dialysis, sepsis, ventilation, increased morbidity, and mortality. CIN is determined by the rise of serum creatinine of equal or greater than 0.5 mg/dl or 25% or more rise in the GFR (Motohiro and others, 2011). The effects from CIN can be seen for up to one year after the procedure. Prophylactic treatment with IV fluids has been researched and it has been determined that IV fluid prophylactic can be advantageous in preventing and reducing the incidence of CIN. In particular sodium bicarbonate IV infusion has been shown to be superior to sodium chloride IV infusion in reducing the incidence of CIN (Ueda and others, 2011). The risk of incidence was reduced by 48.8% when IV fluid hydration is used as a prophylactic (Juarado-Roman and others, 2015). At this time there is no protocol in place on the administration of IV fluids for reducing the incidence of CIN. Implementing a protocol of sodium bicarbonate IV infusion for all patients undergoing cardiac catheterization can help decrease the incidence of CIN therefore reducing the increased morbidity and mortality associated with CIN. The use of sodium bicarbonate IV infusion as a prophylactic to decrease the incidence of CIN can help decrease the length of stay and help control health care costs.

This book describes current examination techniques and advanced clinical applications of state-of-the-art multidetector computed tomography (MDCT) scanners. There are contributions from several distinguished radiologists and clinicians. Each chapter is written from a practical perspective, so that radiologists, residents, medical physicists, and radiology technologists can obtain relevant information about MDCT applications.