Supplementary Material for: Acute Kidney Injury after Valvular Heart Surgery and Early Changes in Cardiac Function and Structure

Background: Acute kidney injury (AKI) following heart surgery is associated with long-term risk of heart failure. It is not known if AKI following valvular heart surgery is associated with early changes in cardiac function or structure. Methods: A cohort study was conducted on 201 patients with AKI and 201 patients without AKI after valvular heart surgery, who were matched for age, sex, left ventricular function, and estimated glomerular filtration rate. AKI was defined as an increase in postoperative serum creatinine of ≥26 Vmol/l (≥0.3 mg/dl) or a relative increase of ≥50%. The two primary outcomes were changes in post- compared with preoperative left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) assessed by echocardiography. Results: The mean age was 72 years, and 33% were female. Aortic valve surgery was the most frequent procedure. The mean time from surgery to the postoperative echocardiographic examination was 4.9 days (SD 3.7). There was no significant change in postoperative mean LVEF (-3.6 vs. -4.3%; p = 0.58) or mean LVEDD (-4.7 vs. -3.9 mm; p = 0.31) in patients with AKI compared to those without AKI. Conclusion: We found no acute changes in cardiac function or structure assessed by echocardiography in patients with AKI compared to those without AKI after valvular heart surgery. i 2014 S. Karger AG, Basel背景：心脏手术后发生的急性肾损伤（Acute kidney injury, AKI）与远期心力衰竭风险相关。目前尚不明确瓣膜性心脏手术后发生的AKI是否与心功能或结构的早期改变存在关联。方法：本队列研究（cohort study）纳入了201例瓣膜性心脏手术后发生AKI的患者，以及201例未发生AKI的患者，两组患者在年龄、性别、左心室功能及估算肾小球滤过率（estimated glomerular filtration rate）上进行了匹配。AKI的定义为术后血清肌酐升高≥26 μmol/L（≥0.3 mg/dl），或相对升高≥50%。两项主要结局指标为通过超声心动图（echocardiography）评估的术后相较于术前的左心室射血分数（left ventricular ejection fraction, LVEF）及左心室舒张末期内径（left ventricular end-diastolic diameter, LVEDD）的变化。结果：受试者平均年龄为72岁，女性占比33%。其中主动脉瓣手术为最常见的术式。从手术至术后超声心动检查的平均时间为4.9天（标准差SD 3.7）。与未发生AKI的患者相比，AKI患者的术后平均LVEF变化（-3.6% vs -4.3%；p=0.58）及平均LVEDD变化（-4.7mm vs -3.9mm；p=0.31）均无显著差异。结论：相较于瓣膜性心脏手术后未发生AKI的患者，本研究未在AKI患者中观察到经超声心动图评估的急性心功能或结构改变。© 2014 S. Karger AG, Basel