Right atrial pressure predicts worsening renal function in patients with acute right ventricular myocardial infarction

• Published in: International journal of cardiology Vol. 264; pp. 25 - 27
• Main Authors: Ivey-Miranda, Juan Betuel, Posada-Martínez, Edith Liliana, Almeida-Gutiérrez, Eduardo, Borrayo-Sánchez, Gabriela, Flores-Umanzor, Eduardo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.08.2018
• Subjects: Aged; Atrial Pressure; Central Venous Pressure; Creatinine - blood; Female; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Humans; Kidney Function Tests - methods; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Predictive Value of Tests; Prognosis; Renal Insufficiency - diagnosis; Renal Insufficiency - etiology; Renal Insufficiency - physiopathology; Right atrial pressure; Right ventricular myocardial infarction; Worsening renal function; Right atrial pressure; Worsening renal function; Right ventricular myocardial infarction
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.12.087

Right ventricular myocardial infarction (RVMI) is associated with serious complications in the short-term. Worsening renal function (WRF) is a frequent and dangerous complication. We investigated if right atrial pressure (RAP) predicts WRF in these patients. We prospectively studied patients with RVMI. RAP was obtained invasively at admission to coronary care unit. Blood samples were extracted from patients at baseline and every 24h for creatinine measurements for seven days. We defined WRF as an increase of 25% or 0.5mg/dl in serum creatinine during the first seven days compared to baseline creatinine. We included forty-five patients (age 68±10years, male 71%). WRF occurred in 51%. The best cut-off value of RAP for WRF prediction was 11mmHg. RAP ≥11mmHg was associated with WRF at univariate analysis (OR 5.5, 95% CI 1.27–24.3, p=0.023) and multivariate analysis (OR 6.1, 95% CI 1.07–35.4, p=0.042). RAP ≥11mmHg improved reclassification and discrimination after usual prediction with the Mehran score (net reclassification improvement 64.8%, p=0.030; integrated discrimination improvement 7.5%, p=0.037). In patients with RVMI, RAP ≥11mmHg predicted WRF and improved discrimination. •Worsening renal function is a frequent complication in right ventricular myocardial infarction.•Right atrial pressure is proposed as a predictor of worsening renal function.•Raised right atrial pressure improved discrimination via the Mehran score.