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Objectives: Diabetes mellitus (DM) and high fasting glucose levels are reportedly risk factors for contrast-induced nephropathy after invasive coronary angiography in patients with renal dysfunction. Cystatin C (CyC) is a sensitive marker for detecting early impairment of renal function. Using CyC, we investigated whether DM would be a risk for worsening renal function after coronary computed tomography angiography (CCTA) in patients with preserved renal function., Methods: Two hundred twenty-eight patients scheduled for CCTA were enrolled. The serum CyC at preprocedure and 1 day after procedure, urinary microalbumin at preprocedure, and oral fluid volume for 24 hours after procedure were measured. The percentage changes in CyC from preprocedure to 1 day after procedure (%CyC) were also calculated., Results: Ninety-eight patients had DM. The %CyC and urinary microalbumin were significantly greater in DM patients than in non-DM patients. The percentage of patients showing a %CyC of 10% or greater was significantly greater in DM patients than in non-DM patients (27% vs 8%, P < 0.01). Using multivariate regression analysis, oral fluid volume and urinary microalbumin were independent predictors for a %CyC of 10% or greater in DM patients (β = - 0.428 [P < 0.0001] and β = 0.464 [P < 0.0001], respectively)., Conclusions: Diabetes mellitus is a risk factor for worsening changes in renal function after CCTA, even in patients with preserved renal function. In particular, elevated microalbuminuria and low oral fluid intake are high-risk factors for renal functional deterioration.

Objectives: Cystatin C (CyC) has recently been recognized as a sensitive marker for potential renal dysfunction. We investigated the role of CyC for evaluating potential kidney injury after computed tomography coronary angiography (CTCA)., Methods: The CyC, serum creatinine (sCr), estimated glomerular filtration rate (eGFR), and blood urea nitrogen (BUN) levels were evaluated before and 1 day and 1 week after the procedure in 140 patients with preserved renal function referred for CTCA. The amount of unrestricted oral fluid intake was measured for 24 hours after CTCA. The relationship between the amount of oral fluid intake and the changes in each renal marker was compared., Results: A strong correlation was observed between oral fluid volume and the changes in CyC (r = -0.80, P < 0.0001) as well as the changes in sCr (r = -0.54, P < 0.0001) and eGFR (r = 0.57, P < 0.0001), but a weak correlation was observed between oral fluid volume and the changes in BUN (r = -0.22, P = 0.03). A progressive rise in a mean level of CyC was observed. The percentage of diabetic history was greater (73% vs 40%, P < 0.001) and oral fluid volume was lower (1142 mL vs 2114 mL, P < 0.0001) in patients with a rise in CyC but without one in sCr than in those showing a rise in neither CyC nor sCr at 1 day postprocedure. Seventy-four (80%) of 92 patients with a rise in CyC at 1 day postprocedure showed a recovery to the baseline sCr levels at 1 week postprocedure, but only 26 (28%) showed a recovery to the baseline CyC levels at 1 week., Conclusions: Cystatin C is a more sensitive marker than sCr in evaluating the effects of oral fluid volume on renal function and in detecting potential kidney injury, especially in diabetic patients after CTCA.

Objectives: We determined the optimal starting time of acquisition after sublingual nitroglycerin (NTG) administration and evaluated the effects on multislice computed tomographic (MSCT) images of a complementary administration of sublingual NTG with beta-blocker., Methods: Sixty patients who underwent MSCT coronary angiography (CA) were randomly divided into 2 groups as follows: 30 patients given an intravenous administration of beta-blocker (landiolol hydrochloride, mean dose of 0.032 mg/kg per minute; group B); and 30 patients given a coadministration of intravenous beta-blocker and sublingual NTG (0.3 mg; group N). Blood pressure and heart rate were recorded every 1 minute after NTG administration. In addition, the maximum diameters of the proximal and distal lesions in each coronary artery were measured, and the number of assessable segments was calculated., Results: Blood pressure significantly decreased and heart rate significantly increased 4 minutes after NTG administration. The number of assessable segments was significantly greater in group N than in group B. The maximum diameters of the distal lesions of the left anterior descending and left circumflex arteries and both proximal and distal lesions of the right coronary artery were significantly larger in group N than in group B., Conclusions: It is advisable to obtain MSCT images after sublingual NTG administration because nitrates are always given during conventional CA and may prevent beta-blocker-induced coronary spasm. The optimal starting time for MSCT CA is approximately 3 minutes after sublingual NTG administration.

Background: Mineralocorticoid receptor antagonism reduces mortality associated with heart failure by mechanisms that remain unclear. The effects of the mineralocorticoid receptor antagonist spironolactone on left ventricular (LV) function and chamber stiffness associated with myocardial fibrosis were investigated in mildly symptomatic patients with idiopathic dilated cardiomyopathy (DCM)., Methods and Results: Twenty-five DCM patients with a New York Heart Association functional class of I or II were examined before and after treatment with spironolactone for 12 months. LV pressures and volumes were measured simultaneously, and LV endomyocardial biopsy specimens were obtained. Serum concentrations of the carboxyl-terminal propeptide (PIP) and carboxyl-terminal telopeptide (CITP) of collagen type I were measured. The patients were divided into 2 groups on the basis of the serum PIP/CITP ratio (< or =35, group A, n=12; >35, group B, n=13), an index of myocardial collagen accumulation. LV diastolic chamber stiffness, the collagen volume fraction, and abundance of collagen type I and III mRNAs in biopsy tissue were greater and the LV early diastolic strain rate (tissue Doppler echocardiography) was smaller in group B than in group A at baseline. These differences and the difference in PIP/CITP were greatly reduced after treatment of patients in group B with spironolactone, with treatment having no effect on these parameters in group A. The collagen volume fraction was significantly correlated with PIP/CITP, LV early diastolic strain rate, and LV diastolic chamber stiffness for all patients before and after treatment with spironolactone., Conclusions: Spironolactone ameliorated LV diastolic dysfunction and reduced chamber stiffness in association with regression of myocardial fibrosis in mildly symptomatic patients with DCM. These effects appeared limited, however, to patients with increased myocardial collagen accumulation.