O.M. Parkhomenko, O.O. Sopko, Ya.M. Lutay, O.I. Irkin, A.O. Stepura, D.O. Bilyi, S.P. Kushnir. Acute cardiorenal syndrome in stable patients with acute coronary syndrome and ST-segment elevation: pathogenetic role of endothelium-dependent vasodilation

The aim – to establish possible clinical and pathogenetic mechanisms of worsening renal function in patients with coronary syndrome (ACS) with ST-segment elevation in the first 7 days of hospital observation.

Material and methods. The study involved 122 patients with ST segment elevation ACS, admitted during the first 4.31±0.23 hours of the disease onset, that received reperfusion therapy (primary PCI – 86.9 % of patients) or who had signs of spontaneous recanalization of infarct-dependent coronary artery (9.0 % of patients). Glomerular filtration rate (GFR) was determined by the calculation method (quadruple MDRD formula). Acute kidney injury or worsening renal function (WRF) was defined as dynamic GFR decline of 20 % or more compared to the original level during period from the 3rd to 7th hospital day. Vascular endothelial function was determined according to the measurement of endothelium-dependent vasodilation (EDVD) at the brachial artery.

Results. Depending on the level of GFR at admission all patients were divided into 3 groups: group 1 – GFR ≥ 90 ml/(min · 1.73 m2); group 2 – GFR 60–89 ml/(min · 1.73 m2); group 3 – GFR 45–59 ml/(min · 1.73 m2). WRF was observed in patients of the 1st group in the presence of more severe endothelial dysfunction within 7 days of follow-up. In patients with moderate renal dysfunction (2nd group) WRF may be associated with endothelial dysfunction on the background of persistent activation of inflammatory processes. In patients with initial renal dysfunction (3rd group) deterioration of their function was accompanied by progressive endothelial dysfunction without elevation of systemic inflammatory response markers.

Conclusions. The results of the study provide evidence of endothelial dysfunction as an important pathogenic factor of kidney function deterioration – acute cardio-renal syndrome in stable patients with ACS. Occurrence of WRF is independent from the baseline GFR but due to initial endothelial dysfunnction – low EDVD at the 1st day of the disease (especially in patients with preserved renal function) and poor recovery of endothelial function during the first week of follow-up (in all groups of patients).

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