Contrast Media – ABC CARDIOL

ABC

Original Article

Ultra-Low Contrast versus Conventional Percutaneous Coronary Intervention for Patients with Baseline Renal Impairment: A Systematic Review and Meta-Analysis of Clinical Outcomes

Marcos Danillo Oliveira et al. Ricardo Fonseca Oliveira Suruagy-Motta Leonardo Dexheimer da Silva Karlos Daniell Araújo dos Santos Adriano Caixeta

Abstract

Background

Contrast-associated acute kidney injury (CA-AKI) results in increased morbidity and mortality, prolonged hospitalization, and worse clinical outcomes. Prior studies have shown that limiting contrast volume (CV) to less than 3 times the estimated glomerular filtration rate (eGFR) implies a lower risk of CA-AKI, and both efficacy and superior outcomes are associated with ultra-low contrast (ULC) volume coronary procedures (total CV ≤ eGFR).

Objectives

This systematic review and meta-analysis aimed to compare clinical outcomes of ULC versus conventional percutaneous coronary intervention (PCI) in patients with chronic kidney disease.

Methods

The search was conducted in the databases PubMed/MEDLINE, Cochrane, Embase, Scopus, and Web of Science, including all studies reporting clinical outcomes of ULC PCI. The primary efficacy endpoint was the incidence of CA-AKI, and secondary endpoints were need for dialysis, all-cause mortality, and major adverse cardiovascular events (MACE), defined as the composite endpoint of all-cause mortality, non-fatal myocardial infarction, and clinically driven target lesion revascularization.

Results

Six studies met the inclusion criteria and were included in the final analysis, encompassing a total of 274,102 patients. ULC PCI was associated with a statistically significant reduction of CA-AKI (risk ratio=0.27; 95% CI=0.13–0.56; p=0.0004). In turn, ULC PCI did not result in statistically significant reduction of need for dialysis (risk ratio=0.33; 95% CI=0.06–1.72; p=0.186), all-cause mortality (risk ratio=0.48; 95% CI=0.17–1.39; p=0.18), and MACE (risk ratio=0.52; 95% CI= 0.21–1.30; p=0.16).

Conclusions

ULC, as compared to conventional PCI, in patients with chronic kidney disease, was found to be safe, feasible, and associated with a statistically significant reduction of CA-AKI. Further, larger, well-powered, randomized, and controlled trials are warranted in order to reassure these findings.

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ABC

Letter to the Editor

Beyond Contrast Volume: Patient-Related Determinants and Methodological Considerations in Contrast-Induced Nephropathy

Ömer Faruk Yilmaz et al. Yusuf Ziya Şener

Dear Editor,

We read with great interest the article by Freitas et al. , entitled “Impact of Contrast Volume Used After Percutaneous Coronary Procedures in Patients at Risk for Contrast-Induced Nephropathy“. By evaluating the interaction between contrast type and volume through a post hoc analysis, the authors addressed a clinically relevant question in a high-risk population managed with contemporary preventive strategies, providing a valuable contribution to the literature.

[…]

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ABC

Letter to the Editor

Volume-Independent Renal Injury: Why Contrast-Induced Nephropathy Can Occur Even at Ultra-Low Contrast Doses

Fahri Çakan

Dear Editor,

I reviewed with great interest the article titled “Impact of Contrast Volume Used After Percutaneous Coronary Procedures in Patients at Risk for Contrast-Induced Nephropathy,” authored by Freitas et al. This post-hoc subgroup analysis, designed to assess contrast-induced nephropathy (CIN) risk management, provides clinically valuable data on the interaction between contrast type and volume, particularly in high-risk patient populations (n=2,268).

[…]

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ABCIC

Original Article

Diagnostic Performance Of Contrast-Enhanced Echocardiography In Differentiating Cardiac Masses: A Systematic Review And Meta-analysis

João Guilherme G. Pedrosa et al. Felizardo José Leandro Pereira Antonio Lacerda Cavalcanti Neto Renata Ramos Stropp … Giordano Persuhn Rolim de Moura Marcelo Tavares Sadrak Lyon Dantas Pontes Alex dos Santos Felix

Abstract

Background

Conventional echocardiography often struggles to differentiate intracardiac masses, particularly in patients with poor acoustic windows. Contrast-enhanced Echocardiography (CEE) overcomes this limitation by visualizing perfusion patterns — distinguishing avascular thrombi from vascularized tumors. We aimed to synthesize existing evidence to evaluate the diagnostic accuracy of CEE.

Objectives

To evaluate the diagnostic accuracy of CEE for differentiating cardiac masses in adults, using histopathology as reference and reporting AUC, sensitivity, specificity, PPV, and NPV.

Methods

Systematic searches of PubMed, Web of Science, Cochrane Library, and EMBASE were performed on August 10, 2025. Studies meeting PICOTT criteria were included; extracted data included sensitivity, specificity, AUC, and 2×2 tables. Pooled estimates were obtained using standard bivariate and SROC models for diagnostic meta-analysis. Statistical significance set at P < 0.05.

Results

Five prospective cohort studies (total n = 381 patients) were included. For tumor vs non-tumor, pooled sensitivity = 100% and specificity = 100% (95% CI 99.5–100%; I² = 0%; heterogeneity P = 0.985), diagnostic odds ratio (DOR) = 3,890.65, AUC = 0.989. For malignant vs benign tumors, pooled sensitivity = 94.3% (95% CI 88.5–97.3%; I² = 0%; P = 0.681), specificity = 96.1% (95% CI 91.5–98.2%; I² = 0%; P = 0.970), DOR = 341.71, SROC AUC = 0.976.

Conclusions

CEE showed very high diagnostic accuracy in the available prospective series. However, the small number of studies and limited sample sizes warrant cautious interpretation; larger prospective multicenter studies with standardized CEE protocols are needed to confirm these results.

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ABC

Original Article

Impact of Contrast Volume Used After Percutaneous Coronary Procedures in Patients at Risk for Contrast-Induced Nephropathy

Rafaela Andrade Penalva Freitas et al. Luiz Fernando Leite Tanajura Amanda Guerra M. R Sousa Fausto Feres José Ribamar Costa

Abstract

Background

Contrast-induced nephropathy (CIN) is a common complication following angiographic procedures, potentially related to the volume of contrast agent administered. However, it is unclear whether the type of contrast also influences its occurrence.

Objective

To evaluate the interaction between contrast volume and contrast type (iso-osmolar vs low-osmolar) in the development of CIN.

Methods

A post hoc subanalysis was performed on patients undergoing diagnostic or therapeutic coronary procedures who were randomized 1:1 to receive low-osmolar or iso-osmolar contrast media. The overall sample (n = 2,268) was stratified by contrast volume: Group I (< 150 mL; n = 1,985) and Group II (≥ 150 mL; n = 283), and groups were compared by contrast type. The primary endpoint was CIN at 48- and 96-hours post-procedure. CIN was defined as a ≥ 25% or ≥ 0.5 mg/dL increase in serum creatinine from baseline at 48 hours. The effects of contrast type and volume were tested with logistic regression including an interaction term, adjusted for acute coronary syndrome, ventricular dysfunction, baseline creatinine, sex, and age (p < 0.05).

Results

We included 2,268 consecutive patients; two-thirds were male; hypertension was present in 85%, diabetes in 52%, and chronic kidney disease in 31%. Mean contrast volume was 75.3 ± 28.0 mL in Group I and 188.6 ± 46.9 mL in Group II. The incidence of CIN was higher with greater volume (14.8% vs 17.7%) but not statistically significant (adjusted odds ratio = 1.25; 95% CI = 0.89-1.73; p = 0.191). The model with the interaction term showed no evidence of an interaction between the type of contrast and volume (p > 0.999).

Conclusion

The type of contrast was not associated with CIN, even among patients exposed to higher contrast volumes.

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ABCIC

Review Article

My approach to optimize my equipment for the use of ultrasound contrast agents

Marcio S. M. Lima

Abstract

Contrast echocardiography, based on ultrasound contrast agents composed of microbubbles, has been increasingly incorporated into echocardiography labs. It involves the infusion of compounds that enhance the visualization of various cardiac and vascular structures. The multiple adjustments required are usually included in pre-configured packages (presets) installed by manufacturers on the equipment. However, it is possible – and sometimes necessary – to make modifications to optimize image generation and, guided by the objective of the echocardiographic study, to achieve the full potential this technique can offer.

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ABC

Original Article

Association between Glucose/lymphocytes Ratio and Contrast-Induced Acute Kidney Injury in Patients with Myocardial Infarction without Diabetes Mellitus

Murat Gök et al. Alparslan Kurtul Orçun Demir Kenan Yalta

Abstract

Background

Glucose metabolism and systemic inflammation appears to be strongly related to many cardiovascular diseases. Glucose to lymphocyte ratio (GLR), a novel promising marker, has been recognized as a reliable predictor of prognosis in various cancers. However, there are still no studies on the association of cardiovascular disease with GLR.

Objectives

This analysis aimed to uncover the potential association between GLR and the risk for contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PPCI) in a ST-elevation acute myocardial infarction (STEMI) population.

Methods

Clinical data of 592 nondiabetic STEMI patients managed with PPCI from February 2021 to February 2023 were retrospectively analyzed. Patients with end-stage kidney disease, missing laboratory data, cancers, inflammatory/infectious diseases, or died during the procedure or within 24 hours after the procedure were excluded. The receiver operating characteristic curve was used to determine the optimal cutoff of GLR in CI-AKI. Based on the cutoff value, the study population was categorized into high-GLR (≥4.16) and low-GLR (<4.16) groups. The level of significance adopted in the statistical analysis was 5%.

Results

The overall CI-AKI incidence was 7.4%. The high-GLR group showed a higher CI-AKI incidence in comparison to the low-GLR group (30.9%vs1.3%, p<0.001). Following adjustment for potential confounders, high-GLR still served as an independent predictor for CI-AKI (odds ratio [OR] 45.100, 95% confidence interval [CI] 7.312-278.174, p<0.001), as well as creatinine at admission (OR:10.459, 95%CI 1.169-93.583, p=0.036).

Conclusions

In conclusion, a high GLR level served as an independent risk factor for CI-AKI evolution after PPCI in subjects with STEMI without diabetes mellitus.

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IJCS

Original Article

Role of the CHA2DS2-Vasc Score in Predicting Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention

Nolly Octavianes Habel Rantung et al. Starry Homenta Rampengan Edmond Leonard Jim Dewa Gde Prema Ananda Fima Lanra Fredrik Gerarld Langi

Abstract

Background

Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) with an onset time <12 h. However, it poses a risk of contrast-induced nephropathy (CIN), occurring in one out of five patients. In this context, the CHA2DS2-VASc score can be used as a predictor of CIN in patients with STEMI undergoing PPCI.

Objectives

To evaluate the role of the CHA2DS2-VASc score in predicting CIN in patients with STEMI who underwent PPCI.

Methods

In this retrospective cohort study, data were collected from the medical records of patients with STEMI who underwent PPCI at the department of cardiovascular medicine of our institution from January 1, 2019, to October 31, 2021. The association of CIN with the CHA2DS2-VASc and Mehran scores, the and neutrophil–lymphocyte ratio were evaluated using a logistic regression model with a p value < 0.05.

Results

This study included 66 patients with CIN from a total of 326 patients with STEMI who underwent PPCI. Patients with CIN showed a higher CHA2DS2-VASc score compared with those without CIN (median [interquartile range — IQR], 2 [1–3] vs. 1 [1–2], p < 0.001). The sensitivity, specificity, negative predictive value, and positive predictive value of the CHA2DS2-VASc score in predicting CIN after PPCI were 73.6%, 92.3%, 87.9%, and 82.1%, respectively.

Conclusion

A CHA2DS2-VASc score ≥ 2.5 is as accurate as a Mehran score ≥6.5 in predicting CIN following PPCI, suggesting that the CHA2DS2-VASc score is a practical and efficient tool for clinical use.

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ABC

Original Article

Effectiveness of Oral Hydration in Preventing Contrast-Induced Nephropathy in Individuals Undergoing Elective Coronary Interventions

Mariana Rodrigues Pioli et al. Renata Muller Couto José de Arimatéia Francisco Diego Quilles Antoniassi … Célia Regina de Souza Matheus Ynada de Olivio Gabriel Forato Anhê Silvio Giopatto Andrei C. Sposito Wilson Nadruz Otavio Rizzi Coelho-Filho Rodrigo Modolo

Abstract

Background

Contrast-induced nephropathy (CIN) is defined as worsening renal function, represented by an increase in serum creatinine of ≥ 25% or ≥ 0.5 mg/dL up to 72 h after exposure to iodinated contrast medium (ICM). The most effective preventive measure to date is intravenous hydration (IVH). Little is known about the effectiveness of outpatient oral hydration (OH).

Objetive

To investigate whether outpatient OH with water is as effective as IVH with 0.9% saline solution in preventing CIN in elective coronary procedures.

Methods

In this retrospective observational study, we analyzed the medical records and laboratory data of individuals undergoing percutaneous coronary procedures with ICM. Data collected between 2012 and 2015 refer to individuals who underwent IVH and those collected between 2016 and 2020 (after implementation of an OH protocol) correspond to individuals who underwent OH at home before and after coronary procedures as instructed by the nursing team. Statistical significance was established at α = 0.05.

Results

In total, 116 patients were included in this study: 58 in the IVH group and 58 in the OH group. An incidence of CIN of 15% (9/58) was observed in the group that received IVH and an incidence of 12% (7/58) was seen in the group that received OH (p = 0.68).

Conclusion

The OH protocol, performed by the patient, appears to be as effective as the in-hospital IVH protocol for the renal protection of individuals susceptible to CIN in elective coronary interventions. These findings should be put to test in larger trials.

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ABCHF

Original Article

Myocarditis: Whole Heart Involvement Revealed by Cardiac Magnetic Resonance Mapping. A Case-control Study

Tiago Bartzen Pereira et al. Maurício Balk Gabriela Bartzen Pereira Victória Schmidt Ramos … Luciano Giordani Paulo R. Schvartzman Luís Beck-da-Silva

Abstract

Background:

Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) only demonstrates regional abnormalities in myocarditis and does not adequately assess diffuse myocardial involvement.

Objective:

To evaluate possible differences in T1 and T2 mapping between ventricular wall segments with and without LGE in patients with myocarditis, compared to control subjects.

Methods:

In a case-control design, 22 patients with CMR evidence of myocarditis and 18 controls with normal CMR were assessed. The study included: (1) T1 mapping (shortened modified Look-Locker Inversion recovery); (2) LGE; (3) T2 mapping (steady-state free precession); and (4) the T2 signal intensity of the myocardium divided by that of skeletal muscle (T2 ratio). T1 and T2 mapping of affected (LGE+) and unaffected (LGE−) ventricular segments of cases were compared, as were those of controls versus cases. The level of significance was set at a two-sided alpha level of 0.05.

Results:

Comparing only patients with myocarditis, ventricular segments with evidence of late enhancement (LGE+) showed a mean T1 value significantly different from that of unaffected (LGE−) ventricular walls (1057 ± 30 versus 1028 ± 48; p = 0.0001). Comparing myocarditis versus controls, the mean T1 value of negative LGE segments in cases (myocarditis +) was significantly different from the mean of the corresponding walls in controls (1028 ± 48 versus 996 ± 10; p < 0.0001). The mean T2 maps of negative LGE walls in cases were not statistically different from those of controls (49 ± 4 versus 49 ± 1; p = 0.9229).

Conclusion:

This case-control study suggests that T1 mapping demonstrates significant involvement of the myocardium of patients with myocarditis, even in the absence of LGE. Specifically, T1 mapping could reveal diffuse myocardial involvement not evidenced by LGE imaging. T2 mapping was noncontributory.

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ABC

Original Article

Sonothrombolysis Promotes Improvement in Left Ventricular Wall Motion and Perfusion Scores after Acute Myocardial Infarction

Bruno G. Tavares et al. Miguel Osman Aguiar Jeane Tsutsui Mucio Oliveira … Alexandre de Matos Soeiro José Nicolau Henrique Ribeiro Hsu PoChiang João Sbano Carlos Eduardo Rochitte Bernardo Lopes José Ramirez Roberto Kalil Filho Wilson Mathias

Abstract

Background

It has recently been demonstrated that the application of high-energy ultrasound and microbubbles, in a technique known as sonothrombolysis, dissolves intravascular thrombi and increases the angiographic recanalization rate in patients with ST-segment–elevation myocardial infarction (STEMI).

Objective

To evaluate the effects of sonothrombolysis on left ventricular wall motion and myocardial perfusion in patients with STEMI, using real-time myocardial perfusion echocardiography (RTMPE).

Methods

One hundred patients with STEMI were randomized into the following 2 groups: therapy (50 patients treated with sonothrombolysis and primary coronary angioplasty) and control (50 patients treated with primary coronary angioplasty). The patients underwent RTMPE for analysis of left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and number of segments with myocardial perfusion defects 72 hours after STEMI and at 6 months of follow-up. P < 0.05 was considered statistically significant.

Results

Patients treated with sonothrombolysis had higher LVEF than the control group at 72 hours (50% ± 10% versus 44% ± 10%; p = 0.006), and this difference was maintained at 6 months of follow-up (53% ± 10% versus 48% ± 12%; p = 0.008). The WMSI was similar in the therapy and control groups at 72 hours (1.62 ± 0.39 versus 1.75 ± 0.40; p = 0.09), but it was lower in the therapy group at 6 months (1.46 ± 0.36 versus 1.64 ± 0.44; p = 0.02). The number of segments with perfusion defects on RTMPE was similar in therapy and control group at 72 hours (5.92 ± 3.47 versus 6.94 ± 3.39; p = 0.15), but it was lower in the therapy group at 6 months (4.64 ± 3.31 versus 6.57 ± 4.29; p = 0.01).

Conclusion

Sonothrombolysis in patients with STEMI resulted in improved wall motion and ventricular perfusion scores over time.

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ABC

Editorial

What Is the Role of Kidney Injury Biomarkers in Contrast-Induced Nephropaty?

Pedro Pimenta de Mello Spineti

Contrast-induced acute kidney injury (CI-AKI) is a potential severe complication in the use of iodinated radiological contrast media and is associated with higher rates of morbidity and mortality and increased length of hospital stay in patients undergoing cardiac catheterization. Its incidence is variable in the literature according to the criteria used for its diagnosis. The CI-AKI definition most often used in clinical trials is an increase in serum creatinine (Cr) levels of 0.5 mg/dl or 25% over baseline within 72 h after exposure to contrast medium.

However, Cr has a number of limitations as a marker of renal function. Its serum level is influenced by external factors such as sex, age, skin color, weight and muscle mass. It underestimates renal function in women, in the elderly or in underweight individuals. Its variation overestimates renal damage in individuals with previous kidney failure. Another important limitation is the fact that Cr rises only after 24 h of an acute kidney injury, being considered a “slow marker” of acute kidney injury.^,

[…]

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ABC

Artigo Original

Blood cell count, sodium, potassium, calcium, osmolality and viscosity, during pediatric angiocardiography with ioxaglate

Mauro Regis Silva Moura et al. Flávio Leboute Carlos Antonio Mascia Gottschall

PURPOSE: Children’s blood changes during angiocardiography may not be only due to the contrast media (CM). METHODS: We studied the presence and severity of changes in those parameters in 35 pediatric patients undergoing angiocardiography with ioxaglate aiming to identify independent variables responsible for those changes. Blood samples were taken at the beginning of the procedure (S1), at the end (S2) and two hours later (S3). RESULTS: Hematocrit: S1= 47.3±6.9%; S2= 40.7± 7.4% (p<0.001), (related to the CM volume r=0.37, p<0.05). Hemoglobin: S1= 15±2.1g%; S2= 13.2±2.4g% (p<0.001), and S3= 12.7±2.5g% (NS). White blood cell count: S1= 7940±3040 leukocytes/mm³; S2= 6950± 2700/mm³ (NS); S3= 10830±4690 leukocytes/mm³, (p<0.001). Procedure duration (r=0.38, p<0.05) and 5% glucose fluid given between S2 and S3 (r=0.49, p<0.05) were isolated. Sodium: S1= 134.5±0.4mEq/L; S2= 130.7±0.4mEq/L (p<0.001) (due to 5% glucose fluid injected, r=0.61, p<0.01). Potassium: S1= 4.22±0.45mEq/L, S2= 3.83±0.4mEq/L (p<0.001). Calcium: S1= 9.13± 1.03mg%; S2= 8.4±0.91mg/dL. (related to the CM, r=0.43, p<0.01.) Osmolality: S1= 293.3±12.5mOsm/kg; S2= 300.6±13.3mOsm/kg (p<0.001). Viscosity: S1= 3.36±0.81; S2= 3.09±0.74 (p<0.01); S3= 3.87±0.89, p<0.001. There was an indirect linear regression with the CM. CONCLUSION: There were profound differences among the dependent variables observed but the ioxaglate was partially related to changes in hematocrit/ hemoglobin, total calcium and viscosity. We failed to demonstrate significant regression coefficient between CM and changes in leukocytes, sodium, potassium, and osmolality.

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