Abnormal hemodynamics is thought to contribute to the increased risk of contrast-induced nephropathy (CIN) and mortality. However, few studies focused on patients without abnormal hemodynamics (defined as hypotension, intra-aortic balloon pump usage) and reduced left ventricular ejection fraction (LVEF < 40%). Our study was to explore the impact of CIN on mortality in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) with relative stable hemodynamics. In this observational study, we included 696 patients with AMI undergoing PCI without reduced LVEF and abnormal hemodynamics. The end point was long-term, all-cause mortality. During the mean follow-up of 2.79 years, CIN was detected in 110 (15.8%) patients. The total all-cause mortality was higher in CIN group than that in non-CIN group (24% vs 3.4%, P < .001). In the multivariate Cox analysis, CIN was an independent predictor of worse outcomes (adjusted hazard ratio [HR]: 2.97, 95% confidence interval: 1.46-6.06, P < .001) and significantly associated with long-term mortality, so did renal insufficiency (adjusted HR: 4.40, P < .001) and use of β-blockers (adjusted HR: 0.33, P < .001). Among patients with AMI, CIN independently predicted long-term mortality following PCI, regardless of LVEF impairment and abnormal hemodynamics.

Background: Heart failure with improved ejection fraction (HFimpEF) is classified as a new type of heart failure, and its prevalence and prognosis are not consistent in previous studies. There is no systematic review and meta-analysis regarding the prevalence and prognosis of the HFimpEF.Method: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library from inception to May 22, 2021 (PROSPERO registration: CRD42021260422). Studies were included for analysis if the prognosis of mortality or hospitalization were reported in HFimpEF or in patients with heart failure with recovered ejection fraction (HFrecEF). The primary outcome was all-cause mortality. Cardiac hospitalization, all-cause hospitalization, and composite events of mortality and hospitalization were considered as secondary outcomes.Result: Nine studies consisting of 9,491 heart failure patients were eventually included. During an average follow-up of 3.8 years, the pooled prevalence of HFimpEF was 22.64%. HFimpEF had a lower risk of mortality compared with heart failure patients with reduced ejection fraction (HFrEF) (adjusted HR: 0.44, 95% CI: 0.33–0.60). HFimpEF was also associated with a lower risk of cardiac hospitalization (HR: 0.40, 95% CI: 0.20–0.82) and the composite endpoint of mortality and hospitalization (HR: 0.56, 95% CI: 0.44–0.73). Compared with patients with preserved ejection fraction (HFpEF), HFimpEF was associated with a moderately lower risk of mortality (HR: 0.42, 95% CI: 0.32–0.55) and hospitalization (HR: 0.73, 95% CI: 0.58–0.92).Conclusion: Around 22.64% of patients with HFrEF would be treated to become HFimpEF, who would then obtain a 56% decrease in mortality risk. Meanwhile, HFimpEF is associated with lower heart failure hospitalization. Further studies are required to explore how to promote left ventricular ejection fraction improvement and improve the prognosis of persistent HFrEF in patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260422, identifier: CRD42021260422.

The triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), and estimated glucose disposal rate (eGDR) serve as surrogate markers of insulin resistance (IR) and are associated with cardiometabolic diseases (CMDs). However, the joint effects of TyG-related indices and eGDR on cardiometabolic multimorbidity (CMM) risk remains unclear. This study aims to assess both separate and combined effects of TyG-related indices and eGDR on CMM. The data of this study derived from the China Health and Retirement Longitudinal Study (CHARLS). TyG-related indices and eGDR were dichotomized at their median levels for participant categorization. Univariate and multivariate Cox regression and restricted cubic splines (RCS) analyzed effects of TyG-related indices and eGDR on CMM, while receiver operating characteristic (ROC) curves, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) assessed their predictive performance. Meanwhile, the mutual mediating effects and interaction effects were further assessed. This study included 5,854 participants (male: 47.5%, median age: 57.0 years). Compared to low TyG-related indices plus high eGDR, High TyG-related indices plus low eGDR had elevated CMM risks: TyG (HR 3.59, 95% CI 2.28–5.65), TyG-BMI (HR 3.40, 95% CI 2.30–5.02), TyG-WC (HR 3.85, 95% CI 2.58–5.75), and TyG-WHtR (HR 3.62, 95% CI 2.43–5.39). Furthermore, the addition of TyG-related indices combined with eGDR to the basic model significantly improved CMM risk prediction: TyG (AUC 0.713, NRI 0.363, IDI 0.008, all p < 0.05); TyG-BMI (AUC 0.729, NRI 0.479, IDI 0.011, all p < 0.05); TyG-WC (AUC 0.716, NRI 0.419, IDI 0.010, all p < 0.05); and TyG-WHtR (AUC 0.717, NRI 0.379, IDI 0.010, all p < 0.05). Moreover, the mediation analysis demonstrated that eGDR significantly mediated all TyG-related indices’ associations with CMM, with only obesity-related TyG indices mediating the association between eGDR and CMM. Notably, no significant additive or multiplicative interaction was observed between any TyG-related indices and eGDR for CMM risk. High TyG-related indices and low eGDR were independently and jointly associated with higher CMM risk. Joint application of TyG-related indices and eGDR could improve early identification and prevention of CMM.

Background: No well‐defined protocols currently exist regarding the optimal rate and duration of normal saline administration to prevent contrast‐induced acute kidney injury ( CI ‐ AKI ) in patients with renal insufficiency. Methods and Results: Hydration volume ratios (hydration volume/weight; HV /W) were calculated in 1406 patients with renal insufficiency (estimated glomerular filtration rate [ eGFR ], <90 mL/min per 1.73 m ² ) undergoing percutaneous coronary intervention ( PCI ) with routine speed hydration (1 or 0.5 mL/kg per hour). We investigated the relationship between hydration volume, risk of CI ‐ AKI (increase in serum creatinine ≥0.5 mg/dL or 25% within 48–72 hours), and prognosis. Mean follow‐up duration was 2.85±0.88 years. Individuals with higher HV /W were more likely to develop CI ‐ AKI (quartiles: Q1, Q2, Q3, and Q4: 4.3%, 6.6%, 10.9%, and 15.0%, respectively; P <0.001). After adjusting 12 confounders, including age, sex, eGFR , anemia, emergent PCI , diabetes mellitus, chronic heart failure, diuretics, contrast volume, lesions, smoking status, and number of stents, multivariate analysis showed that a higher HV /W ratio was not associated with a decreased CI ‐ AKI risk (Q2 vs Q1: adjusted odds ratio [ OR ], 1.13; Q3 vs Q1: adjusted OR , 1.51; Q4 vs Q1: adjusted OR , 1.87; all P >0.05) and even increased CI ‐ AKI risk ( HV /W >25 mL/kg: adjusted OR , 2.11; 95% CI , 1.24–3.59; P =0.006). Additionally, higher HV /W was significantly associated with an increased risk of death (Q4 vs Q1: adjusted hazard ratio, 3.44; 95% CI , 1.20–9.88; P =0.022). Conclusions: Excessively high hydration volume at routine speed might be associated with increased risk of CI ‐ AKI and death post‐ PCI in patients with renal insufficiency.

Background—: Few studies have investigated the safe limits of contrast to prevent contrast-induced nephropathy (CIN) based on hydration data. We aimed to investigate the relative safe maximum contrast volume adjusted for hydration volume in a population with a relatively low risk of CIN. Methods and Results—: The ratios of contrast volume-to-creatinine clearance (V/CrCl) and hydration volume to body weight (HV/W) were determined in patients undergoing cardiac catheterization. Receiver–operator characteristic curve analysis based on the maximum Youden index was used to identify the optimal cutoff for V/CrCl in all patients and in HV/W subgroups. Eighty-six of 3273 (2.6%) patients with mean CrCl 71.89±27.02 mL/min developed CIN. Receiver–operator characteristic curve analysis indicated that a V/CrCl ratio of 2.44 was a fair discriminator for CIN in all patients (sensitivity, 73.3%; specificity, 70.4%). After adjustment for other confounders, V/CrCl >2.44 continued to be significantly associated with CIN (adjusted odds ratio, 4.12; P <0.001) and the risk of death (adjusted hazard ratio, 2.62; P 12 mL/kg). The best cutoff value for V/CrCl was 1.87 (sensitivity, 67.9%; specificity, 64.4%; adjusted odds ratio, 3.24; P =0.011) in the insufficient hydration subgroup (HV/W, ≤12 mL/kg; CIN, 1.32%) and 2.93 (sensitivity, 69.0%; specificity, 65.0%; adjusted odds ratio, 3.04; P =0.004) in the sufficient hydration subgroup (HV/W, >12 mL/kg; CIN, 5.00%). Conclusions—: The V/CrCl ratio adjusted for HV/W may be a more reliable predictor of CIN and even long-term outcomes after cardiac catheterization. We also found a higher best cutoff value for V/CrCl to predict CIN in patients with a relatively sufficient hydration status, which may be beneficial during decision-making about contrast dose limits in relatively low-risk patients with different hydration statuses.