The symptoms of atrial fibrillation (AF) may resemble those of coronary artery disease (CAD), reflecting the difficulty of making an invasive diagnosis in patients with AF. Extensive coronary angiography may be unnecessary and even put patients at risk of post-angiographic acute kidney injury (PC-AKI), especially in patients with chronic kidney disease (CKD). Our aim was to investigate a hypothesis suggesting a higher prevalence of PC-AKI in patients with atrial fibrillation scheduled for coronary angiography. The study population included 8026 patients with elective coronary angiography, 1621 of whom were patients with atrial fibrillation. In the comparison of the prevalence of PC-AKI in the different groups, we can see that in both groups with CKD (CKD ( plus )/AF ( plus ) 6.24 percent vs. CKD ( plus )/AF (-) 3.04 percent ) and without CKD (CKD (-)/AF ( plus ) 2.32 percent vs. -)/AF(-) 1.22 percent ) in patients with AF, the incidence of renal impairment was twice as high. In our study, post-contrast acute renal disease was twice as common in patients with AF, especially in the subgroup with chronic renal disease scheduled for coronary angiography. Furthermore, considering previous findings suggesting that AF is associated with non-obstructive coronary artery disease on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agents and may develop complications.

atrial fibrillation; post-contrast acute kidney injury; acute kidney injury; chronic kidney disease; coronary artery disease; .

Atrial fibrillation (AF) is the most common arrhythmia, while coronary artery disease (CAD) is the most common cardiovascular disease and remains the leading cause of death worldwide [1,2]. Both conditions share some common risk factors - smoking, obesity, diabetes, obstructive sleep apnea, and elevated blood pressure. Moreover, some of the symptoms overlap, so AF presentation can mimic coronary artery disease [3-7]. Considering the lack of significant coronary lesions associated with atrial fibrillation on angiography [8], this raises difficulties in identifying patients with atrial fibrillation for invasive diagnosis.

Chronic kidney disease (CKD) shares some of these risk factors, and its co-occurrence with atrial fibrillation is becoming increasingly common in the general population [9].CKD is also associated with an increased incidence of post-coronary angiography acute kidney injury (PCAKI). The pathophysiology of PC-AKI is unclear, so new studies should continue to explore this topic as well as methods of prevention [10,11].

A substantial number of coronary angiographies may be unnecessary or even put the patient at risk of post-contrast acute kidney injury, especially in patients with chronic kidney disease (CKD). Therefore, our goal was to investigate the hypothesis indicating a higher prevalence of post-contrast acute kidney failure in patients with AF scheduled for coronary angiography. As shown in Figure 1, the cohort of participants was divided into four groups as follows: CKD( plus )/AF ( plus ), CKD( plus )/AF(-); CKD (-)/AF ( plus ); CKD(-)/AF (-).

į poveikis Cistanche on inkstai

Medžiagos ir Metodas

Mes peržiūrėjome the medical records of 26985 coronary angiography patients hospitalized in the Department of Invasive Cardiology at the Medical University of Białystok (Białystok, Poland) from 2007 to 2016. We excluded patients with the chronic coronary syndrome (CCS), acute coronary syndrome (ACS), acute coronary syndrome (ACS), and who undercovered percutaneous coronary intervention (PCI) or angiography before heart valve surgery. Dializė ir missing kreatininas vertės buvo taip pat išimtis kriterijai (pav. 1).

Paveikslas 1. Atranka iš tyrimas populiacija.

Ultimately, our final study cohort included 8026 patients. All patients had. No coronary angiography was available. Non-ionic radiographs containing iodine during the procedure. A contrast agent was used. The same radiographic contrast prophylaxis strategy was used in all patients. Coronary angiography was performed according to the Judkins technique [12] The diagnosis of CCS and indication for PCI was performed according to current ESC guidelines (13. Severe coronary stenosis was defined as more than 50 percent of the left coronary artery trunk and more than 70 percent of the remaining vessels. the degree of CCS was classified as single, double, or multiple lesions.

CKD-EPI eGFR and creatinine levels were assessed on admission. The term PCAKI was used based on a recommendation-based distinction, which dictated the use of the term contrast-induced acute kidney injury (CI-AKI) only if we could determine a causal relationship between contrast administration and acute kidney injury, rather than PC-AKI [14]. In the present study, PC-AKI was defined as an increase in absolute serum creatinine Greater than or equal to 0.5 mg/dL or Greater than or equal to 25 percent increase relative to baseline values within {{10}} h after intervention [15]. The same strategy for the prevention of radiographic contrast was used in all patients - 1000 mL of 0.9 percent NaCl intravenous hydration and preoperative discontinuation of metformin, regardless of eGFR values [16]. As for the volume of contrast, each patient was given a specific volume according to the procedure specifications:40 mL for diagnostic coronary angiography and 55 mL for diagnostic coronary angiography with left ventricular angiography. The volume of contrast used for diagnostic catheterization and PCI depended on the complexity of the procedure, for example, the number of stents.

The subgroup of patients with atrial fibrillation was defined as a diagnosis that showed atrial fibrillation on ECG and/or was found in the medical record during hospitalization. Diagnosis and atrial fibrillation classification were based on the physician-specified diagnosis in the medical record and/or the presence of the corresponding ICD-10 code [17]. Less than 1 percent of the data were missing and these were excluded from the analysis.

The distribution of variables was assessed using the Kolmogorov-Smirnov test. Data were expressed as mean and standard deviation (SD). Relative frequencies were used to indicate categorical variables.

Student's t-test and Mann-Whitney test were used to compare whether the differences between PC-AKI patients and non-PC-AKI patients were statistically significant.

For non-normally distributed variables, we used the Kruskal-Wallis test and the steel was - Critchlow - flinger procedure for multiple two-by-two comparisons, and the χ ²

Multivariate backward stepwise selection logistic regression was used to determine the ratio of acute kidney injury after contrast. The model included all predictors with p values less than 0.1 and no significant multicollinearity effects. Variance inflation factors were used to determine the correlation between the independent variables and the strength of the correlation. Data were expressed as dominance ratios with 95 percent confidence intervals.

A p-value ＜0.05 was considered a statistically significant difference. Statistical software Microsoft Excel (Microsoft, version 16.40, Redmond, WA, USA, 2020) and XL Stat (Addinsoft, version 2020.03.01, New York, NY, USA, 2020) were used.

A total of 8026 patients were eligible for the study, more than half of whom were men (54.06 percent ) with a mean age of 65.26 years (SD=10.14). Separate analyses were performed to differentiate patients according to the presence or absence of AF and CKD.

Men predominated among patients with PC-AKI (70.06 percent (N=110) vs. 53.74 (N=4229), p < 0.001). They were more likely to have atrial fibrillation (37.58 percent (N=59) vs. 19.85 (N=1562), p < 0.001), chronic kidney disease (42.68 percent (N=67) vs. 19.85 (N=1562), p < 0.001), lower mean ejection fraction (41.53 (SD=16.97) vs. 50.43 (SD=13.29), p < 0.001), and were also more likely to have significant stenosis (58.6 percent (N=92) vs 39.94 (N=3144), p < 0.001). In addition, PC-AKI patients were more often treated with NOAC (p=0.03) and VKA (p=0.008) anticoagulants.

There were significant differences in clinical characteristics between the group with AF and CKD and the group without AF and CKD. Comparing the two CKD( plus ) subgroups, the AF group was twice as likely to have PC-AKI as the no-AF group (6.24 percent (N=34) vs. 3.04 percent (N=33), p < {{20}}.001). the CKD(-)/AF( plus ) group was more likely to have significant stenosis than the CKD(-)/AF( The CKD(-)/AF( plus ) group had more frequent significant stenosis than the CKD(-)/AF( plus ) group (33.55 percent (N=361) vs. 39.3 percent (N=2091), p < 0.001). fibrinogen and serum creatinine concentrations were highest in the CKD( plus )/AF( plus ) subgroup (p < 0.001). Patients without CKD and AF had the highest eGFR values (p < 0.001).

In the comparison of the prevalence of PC-AKI in the differentiated groups, we can see that in both groups of AF patients with CKD (CKD ( plus )/AF ( plus ) 6.24 percent vs. CKD ( plus )/AF (-) 3.04 percent ) and without CKD (CKD (-)/AF ( plus ) 2.32 percent vs. CKD (-)/AF (-) 1.22), the impairment of renal function The incidence of the disease was two times higher（figure 2）.

The inpacence of has increase in the last few years and will continue to increase in the coming years, with an estimated 17.9 million cases in Europe by 2060 [4,18]. There are many factors that determine the origin of AF, from hypertension, valve defects, diabetes mullitus, and hyperthyroism to heart failure and coronary artery disease [19,20].

paplitimas prieširdžių virpėjimas in pacientai su koronarine arterija liga is žema, up to 5 procentai , o paplitimas paplitimas koronarinė arterija liga in pacientai su prieširdžių virpėjimu can reach aukštesnės vertės [21,22]. in mūsų tyrimas, the paplitimas of CAD buvo 37,51 procentas in pacientai su prieširdžių virpėjimu ir 41,01 procentais in pacientai su sinusu ritmu. Pagal į kitus tyrimus, šis skaičius skiriasi nuo 17 procentų iki 46,5 procentai [23-26].

Pacientai in the early stages of the disease were referenced to invazive diagnosis-coronary angiography nes of the expacrbation of AF symptoms reflected in the EHRA scale, as CAD-like symptoms manifested [27]. Conventional stress testing as an available noninvasive diagnostic method for CAD may be inclusive inclusive in patients with atrial fibrillation. Pradhan et al. stebėta in jų tyrimas kad st-segmentas lašas per greitas prieširdžių virpėjimas did ne prognozuoti buvimas of obstrukcinis koronarinė arterija liga [28]. Vienas fotonas emisija kompiuterija tomografija (SPECT) mankšta testavimas taip pat parodyta ribotas tikslumas in ši grupė iš pacientų [29]. Dobutaminas stresas echokardiografija is a gerai alternatyva to CAD [30] even in pacientai su prieširdžių virpėjimu ir buvo ras to to be labai tiksliai, but gydytojai are nenori to turi šios testai atlikta in pacientai su paroksizminiu prieširdžių virpėjimu nes jie žino kad pacientai su paroksizminiu prieširdžių virpėjimu gali priežastimi prieširdžių virpėjimu epizodais. In papildymas, CT scans reikalauti a slow heart rate, which is beveik neįmanoma in pacientai su AF. Todėl, duota visi the limitai of other diagnostika metodai, koronarinė angiografija lieka the preferred option, nepaisant the potencialas for komplikacijos.

Vienas iš galimas komplikacijos po koronarinė angiografija is po kontrasto ūminis inkstų sužalojimas (PC-AKI), ir pacientai su LIL yra žinoma to be at a didesnė rizika iš šio neigiamo rezultato [31]. In papildymas to šios asociacijos, the development of PC-AKI may lead to the development of chronic inkstai liga ir prognozuoja prasti rezultatai in pacientai išgyvenami perkutaniniai koronarinė intervencija dėl ūminiai koronariniai sindromai [7,32]. Dėl ilgalaikis neigiamas poveikis of PC-AKI, nuomonės are prieštaringas dėl to the lack of direct priežastingumas in the study, but padidėjimas mirtingumas, progresavimas iš lėtinis inkstų liga, ir inkstų nepakankamumas buvo pastebėta [11]. In papildymas į CKD, veiksniai prisidedantys į pokontrastą ūminį inkstų sužalojimą įtraukti senas amžius, hemodinaminis nestabilumas, stazinis širdis nepakankamumas, diabetas cukrinis, anemija, ir kontrastas tūris % 5b10,33]. In papildymas, tyrėjai are search for markers that can detect PC-AKI early and implement appropriate therapeutic strategies that may improve clinical outcomes. a recent meta-analysis by Li et al. show that BNP or NT-proBNP has a valid predictive value in the identification of acute inkstų injury [34]. a study by Chen et al. show that long-chain non-coding RNR -HILPDA and - PRND may be novel biomarkers for this region su 100 procentas jautrumas ir 83.93 procentas specifiškumas [35].

Cistanche milteliai

Keli dideli populiacija tyrimai turi nuosekliai parodė a didesnis paplitimas iš prieširdžių virpėjimo in pacientų su LIL ne in pacientai be the inkstų ligos [36]. Svarstymas šis, it gali būti manoma kad pacientai su šia grupe iš gretutinių ligų gali priklauso priklauso to a didelės rizikos grupė už po kontrasto ūminis inkstų sužalojimas. Tai yra atsispindėjo in mūsų analizė, kur PCAKI buvo tiesiogiai susiję su the occurrence of AF, CKD, CAD, lėtinis širdis nepakankamumas, ir vyrai. Svarstymas šie rezultatai, it is taip pat svarbu imtis tinkamai atsargumo priemonės to vengti inkstų pažeidimo in pacientai reikalaujantys koronarinė angiografija [37,38].

Potential mechanisms that may contribute to the development of contrast nephropathy in patients with AF may include acute hemodynamic changes due to sedation during the procedure, transient atrial shock, other serious comorbidities, and hypovolemia in the fasting state that may lead to renal hypoperfusion [39,40]. Mechanical atrial shock may be associated with the lack of immediate improvement in cardiac output after PCI and may be a contributing factor to decreased renal perfusion [41]. In addition, blood volume status should be optimized prior to PCI with the judicious use of diuretics to avoid hypovolemia or, if possible, better discontinuation of diuretics. The presence of CKD is a known risk factor for AKI; however, this relationship is difficult to assess due to the presence of many confounding factors [42]. Microthromboembolism is thought to play a role in CKD and cognitive decline [43]. This may also be associated with AKI. In a recent study, Wang et al. [44] published the incidence and risk factors of hospitalization for atrial fibrillation in patients with hospitalized AKI. They found that the detection rate of hospitalized AKI in Chinese patients with atrial fibrillation was 8.0 percent . Risk factors for hospitalized AKI in this population were age (increasing every 10 years), preadmission diuretic use, and baseline hemoglobin (decreasing every 20 g/L).

In addition, Harel et al. [45] evaluated the risk of AKI in elderly patients older than 66 years with atrial fibrillation in a recent population-based cohort study of 20,683 outpatients in Ontario, Canada, with newly prescribed DOAC (dabigatran, rivaroxaban or apixaban) compared with warfarin. They hypothesized several mechanisms of anticoagulant-induced AKI, such as systemic bleeding leading to hypotension, acute interstitial nephritis, and anticoagulant-associated nephropathy (a disease mediated by glomerular bleeding leading to the formation of an obstructive red blood cell model in the distal tubule and free radical damage caused by lysed red blood cells at anticoagulation hypnotherapeutic levels [46,47]. However, due to retrospective analysis, we were unable to establish a causal relationship between AKI/CKD and AF therapy. Brodsky and Hebert [48] discussed anticoagulation-related nephropathy in a review. They emphasized that it occurs mainly in those AKI that already have multiple risk factors (e.g., CKD, cardiovascular disease, and diabetes), i.e., AKI is multifactorial. Furthermore, the diagnosis is exclusionary unless a renal biopsy is performed, and nephrologists are naturally reluctant to consider renal biopsies in anticoagulated patients because of the higher risk of bleeding. These potential mechanisms are only speculative based on observational data and require further study. Similar mechanisms other than contrast agents may underlie the deterioration of renal function after DC reversal [49].

Overall, coronary angiography is the most effective method to assess coronary vascularity, especially in patients with acute coronary syndromes. In one of our previous studies, we observed that a significant number of patients with atrial fibrillation did not have significant coronary stenosis on coronary angiography [50]. In the current analysis, 62.49 percent of patients with atrial fibrillation showed non-obstructive coronary artery disease on angiography. Considering that many symptoms of coronary artery disease and atrial fibrillation overlap, it is crucial to use all non-invasive methods to differentiate them. In this way, the proportion of patients with atrial fibrillation with unremarkable coronary angiography will be reduced, and therefore the amount of PC-AKI will be reduced.

In our study, post-contrast acute kidney disease was twice as common in patients with atrial fibrillation, especially in the subgroup with chronic kidney disease scheduled for coronary angiography. In addition, considering previous findings suggesting that AF is associated with non-obstructive coronary artery disease on angiography, patients with AF and CKD may be unnecessarily exposed to contrast and may develop complications.

is a dykuma augalas kad buvo naudota in tradicinė kinų medicina šimtmečiams nes iš jos sveikata nauda. Vienas iš the main areas where Cistanche is thought to have positive effects is on the inkstai. In this article, we will explore the įvairių ways in which Cistanche affects the inkstai ir kaip it can benefit tie kenčiantys nuo su inkstais susijusios ligos.

Vienas iš labiausiai reikšmingi poveikis iš Cistanche on the inkstai is jos gebėjimas to pagerinti inkstai funkcija. Tai buvo parodyta in keli tyrimai kur pacientai su inkstų liga buvo duota Cistanche papildai. The results show that Cistanche help to reduce inflammation, improve blood flow to the inkstai, and increase the excret of waste products from the body.

NUORODOS

1. Menezes, A.R.; Lavie, C.J.; Di Nicolantonio, J.J.; O'Keefe, J.; Morin, D.P.; Khatib, S.; Milani, R.V. Prieširdžių virpėjimas in the 21st century: A current understanding of risk factors and primary prevention strategies. Mayo Clin. Proc. 2013, 88, 394–409.

2. Gaziano, T.A.; Bitton, A.; Anand, S.; Abrahams-Gessel, S.; Murphy, A. Growing epidemic of coronary heart disease in low- and middle-income countries. Curr. Probl. Cardiol. 2010, 35, 72–115.

3. Malakar, A.K.; Choudhury, D.; Halder, B.; Paul, P.; Uddin, A.; Chakraborty, S. A review on coronary artery disease, its risk factors, and therapeutics. J. Cell Physiol. 2019, 234, 16812–16823.

4. Staerk, L.; Sherer, J.A.; Ko, D.; Benjamin, E.J.; Helm, R.H. Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circ. Res. 2017, 120, 1501–1517.

5. Ku´zma, Ł.; Pogorzelski, S.; Struniawski, K.; Bachórzewska-Gajewska, H.; Dobrzycki, S. Exposure to air pollution-a trigger for myocardal infarktas? A nine-year study in Bialystok-the capital of the Green Lungs of Poland (BIA-ACS registry). Int. J. Hyg. Environ. Health 2020, 229, 113578.

6. Ku ´Zuma, Ł.; Pogorzelski, S.; Struniawski, K.; Dobrzycki, S.; Bachórzewska-Gajewska, H. Poveikis of air pollution on the number of hospital admissions for a acute coronary syndrome in senyviems žmonėms pacientams. Pol. Arch. Intern. Med. 2020, 130, 38–46.

7. Ku´zma, Ł.; Małyszko, J.; Kurasz, A.; Niwi ´ska, M.; Zalewska-Adamiec, M.; Bachórzewska-Gajewska, H.; Dobrzycki, S. Impact of renal function on patients with acute coronary syndromes: 15,593 patient-years study. Ren. Card. Fail. 2020, 42, 881–889.

8. AFFIRM Tyrėjai; Prieširdžių Virpėjimas Stebėjimas Tyrimas Ritmas Valdymas. Bazinė Charakteristikos iš pacientų su prieširdžių virpėjimu: The AFFIRM Study. Am. Heart J. 2002, 143, 991–1001.

9. Baber, U.; Howard, V.J.; Halperin, J.L.; Soliman, E.Z.; Zhang, X.; McClellan, W.; Warnock, D.G.; Muntner, P. Association of chronic kidney disease with atrial fibrillation among adults in the United States: Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Circ. Arrhythm. Electrophysiol. 2011, 4, 26–32.

10. Ozkok, S.; Ozkok, A. Contrast-Induced acute kidney injury: A review of practical points. World J. Nephrol. 2017, 6, 86–99.

11. Rudnick, M.R.; Leonberg-Yoo, A.K.; Litt, H.I.; Cohen, R.M.; Hilton, S.; Reese, P.P. The Controversy of Contrast-Induced Nephropathy with intravenous contrast: What is the risk? Am. J. Kidney Dis. 2020, 75, 105–113.

12. Judkins, M.P. Percutaneous transfemoral selective coronary arteriography. Radiol. Clin. N. Am. 1968, 6, 467–492.

13. Montalescot, G.; Sechtem, U.; Achenbach, S.; Andreotti, F.; Arden, C.; Budaj, A.; Bugiardini, R.; Crea, F.; Cuisset, T.; Di Mario, C.; et al. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur. Heart J. 2013, 34, 2949–3003.

14. Van der Molen, A.J.; Reimer, P.; Dekkers, I.A.; Bongartz, G.; Bellin, M.F.; Bertolotto, M.; Clement, O.; Heinz-Peer, G.; Stacul, F.; Webb, J.A.W.; et al. Post-Contrast acute kidney injury—Part 1: Definition, clinical features, incidence, the role of contrast medium and risk factors: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur. Radiol. 2018, 28, 2845–2855.

15. Solomon, R.; Dauerman, H.L. Contrast-Induced acute kidney injury. Circulation 2016, 122, 2451–2455.

16. Van der Molen, A.J.; Reimer, P.; Dekkers, I.A.; Bongartz, G.; Bellin, M.F.; Bertolotto, M.; Clement, O.; Heinz-Peer, G.; Stacul, F.; Webb, J.A.W.; et al. Post-Contrast acute kidney injury. Part 2: Risk stratification, the role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur. Radiol. 2018, 28, 2856–2869.

17. Kirchhof, P.; Benussi, S.; Kotecha, D.; Ohlsson, A.; Atar, D.; Casadei, B.; Castella, M.; Diener, H.C.; Heidbuchel, H.; Hendriks, J.; et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. J. Cardio-Thorac. Surg. 2016, 50, e1–e88.

18. Lippi, G.; Sanchis-Gomar, F.; Cervellin, G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int. J Stroke 2020, 16, 217–221.

19. Chlabicz, M.; Jamiołkowski, J.; Paniczko, M.; Sowa, P.; Łapi ´nska, M.; Szpakowicz, M.; Jurczuk, N.; Kondraciuk, M.; Raczkowski, A.; Sawicka, E.; et al. Independent Impact of Gynoid Fat Distribution and Free Testosterone on Circulating Levels of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) in Humans. J. Clin. Med. 2019, 9, 74.

20. Brandes, A.; Smit, M.D.; Nguyen, B.O.; Rienstra, M.; Van Gelder, I.C. Risk Factor Management in Atrial Fibrillation. Arrhythm. Electrophysiol. Rev. 2018, 7, 118–127.

21. Cameron, A.; Schwartz, M.J.; Kronmal, R.A.; Kosinski, A.S. Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry). Am. J. Cardiol. 1988, 6, 714–717.

22. Otterstad, J.E.; Kirwan, B.A.; Lubsen, J.; De Brouwer, S.; Fox, K.A.; Corell, P.; Poole-Wilson, P.A.; Action Investigators. Incidence and outcome of atrial fibrillation in stable symptomatic coronary disease. Scand. Cardiovasc. J. 2006, 40, 152–159.

23. Michniewicz, E.; Mlodawska, E.; Lopatowska, P.; Tomaszuk-Kazberuk, A.; Malyszko, J. Patients with atrial fibrillation and coronary artery disease—Double trouble. Adv. Med. Sci. 2018, 63, 30–35.

24. Connolly, S.J.; Ezekowitz, M.D.; Yusuf, S.; Eikelboom, J.; Oldgren, J.; Parekh, A.; Pogue, J.; Reilly, P.A.; Themeles, E.; Varrone, J.; et al. RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2009, 17, 1139–115151.

25. Lip, G.Y.H.; Beevers, D.G. ABC of atrial fifibrillation. History, epidemiology, and importance of atrial fibrillation. Br. Med. J. 1995, 311, 1361.

26. Kralev, S.; Schneider, K.; Lang, S.; Süselbeck, T.; Borggrefe, M. Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography. PLoS ONE 2011, 6, e24964.

27. Wynn, G.J.; Todd, D.M.; Webber, M.; Bonnett, L.; McShane, J.; Kirchhof, P.; Gupta, D. The European Heart Rhythm Association symptom classification for atrial fibrillation: Validation and improvement through a simple modification. Europace 2014, 16, 965–972.

28. Pradhan, R.; Chaudhary, A.; Donato, A.A. Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease. Am. J. Emerg. Med. 2012, 30, 1042–1047.

29. Gimelli, A.; Liga, R.; Startari, U.; Giorgetti, A.; Pieraccini, L.; Marzullo, P. Evaluation of ischemia in patients with atrial fibrillation: Impact of stress protocol on myocardial perfusion imaging accuracy. Eur. Heart J. Cardiovasc. Imaging 2015, 16, 781–787.

30. Hobday, T.J.; Pellikka, P.A.; Attenhofer Jost, C.H.; Oh, J.K.; Miller, F.A., Jr.; Seward, J.B. Chronotropic response, safety, and accuracy of dobutamine stress echocardiography in patients with atrial fibrillation and known or suspected coronary artery disease. Am. J. Cardiol. 1998, 82, 1425–1427.

31. Mehran, R.; Aymong, E.D.; Nikolsky, E.; Lasic, Z.; Iakovou, I.; Fahy, M.; Mintz, G.S.; Lansky, A.J.; Moses, J.W.; Stone, G.W.; et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J. Am. Coll. Cardiol. 2004, 44, 1393–1399.

32. Yang, Y.; George, K.C.; Luo, R.; Cheng, Y.; Shang, W.; Ge, S.; Xu, G. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: A meta-analysis. BMC Nephrol. 2018, 19, 374.

33. Liu, Y.; Liang, X.; Xin, S.; Liu, Y.; Liang, X.; Xin, S.; Liu, J.; Sun, G.; Chen, S.; Cen, X.; et al. Risk factors for contrast-induced acute inkstų injury (CI-AKI): Protocol for systematic review and meta-analysis. BMJ Open 2019, 9, e030048.

34. Xiaoming, L.; Chao, L.; Zhi, M.; Shuang, Q.; Renjie, S.; Feihu, Z. Brain Natriuretic Peptide for Predicting Contrast-Induced Acute In Inkstai Trauma in Pacientai su Ūminiu Koronariniu Sindromu Atliekama Koronarinė Angiografija: A Sisteminė Apžvalga ir Metaanalizė. J. Interv. Cardiol. 2020, 2020, 1035089.

35. Chen, G.; Liu, B.; Chen, S.; Li, H.; Liu, J.; Mai, Z.; Chen, E.; Zhou, C.; Sun, G.; Guo, Z.; et al. Novel biomarkers for post-contrast acute inkstų injury identified from long non-coding RNR expression profiles. Int. J. Biol. Sci. 2021, 17, 882–896.

36. Kulkarni, N.; Gukathasan, N.; Sartori, S.; Baber, U. Lėtinis Inkstas Liga ir Prieširdžių Virpėjimas: A Šiuolaikinis Apžvalga. J. Atr. Virpėjimas 2012, 5, 448.

37. Almendarez, M.; Gurm, H.S.; Mariani, J., Jr.; Montorfano, M.; Brilakis, E.S.; Mehran, R.; Azzalini, L. Procedural Strategies to Reduce the Incidence of Contrast-Induced Acute Inkstai Trauma During Percutaneous Coronary Intervention. JACC Cardiovasc. Interv. 2019, 12, 1877–1888.

38. Vandenberghe, W.; Hoste, E. Contrast-Associated acute inkstų trauma: Does it really exist, and if so, what to do about it? F1000Res 2019, 8, 753.

39. Sanders, N.A.; Bertolone, C.; Jetter, T.L.; Wasmund, S.L.; Croci, F.; Solano, A.; Brignole, M.; Hamdan, M.H. Atstatymas sinusas ritmas rezultatai in kraujas spaudimas sumažėjimas in pacientai su nuolatiniu prieširdžių virpėjimu ir a istorija hipertenzija. J. Kardiovasc. Elektrofiziol. 2012, 23, 722–726.

40. Jacob, M.; Chappell, D. Effects of perioperacinis badavimas on hemodinamika ir intravaskuliniai tūriai. Best Pract. Res. Clin. Anesteziolis. 2012, 26, 421–430.

41. Khan, I.A. Atrial stunning: Basics and clinical considerations. Int. J. Cardiol. 2003, 92, 113–128.

42. Singh, P.; Rifkin, D.E.; Blantz, R.C. Chronic kidney disease: An inherent risk factor for acute kidney injury? Clin. J. Am. Soc. Nephrol. 2010, 5, 1690–1695.

43. Corrao, S.; Argano, C.; Nobili, A.; Marcucci, M.; Djade, C.D.; Tettamanti, M.; Pasina, L.; Franchi, C.; Marengoni, A.; Salerno, F.; et al. Brain and inkstai, aukos iš prieširdžių mikro embolijos in pagyvenę hospitalizuoti pacientai? Duomenys nuo the REPOSI tyrimas. Eur. J. Intern. Med. 2015, 26, 243–249.

44. Wang, G.; Yang, L.; Ye, N.; Bian, W.; Ma, C.; Zhao, D.; Liu, J.; Hao, Y.; Yang, N.; Cheng, H. Ligoninėje ūminis inkstų trauma ir prieširdžių virpėjimas: Dažnis, rizika faktoriai, ir rezultatas. Ren. Fail. 2021, 43, 949–957.

45. Harel, Z.; McArthur, E.; Jeyakumar, N.; Sood, M.; Garg, A.; Silver, S.; Dorian, P.; Blum, D.; Beaubien-Souligny, W.; Yan, A.; et al. The Risk of Acute Inkstai Trauma su Oral Antikoaguliantais in Pagyvenę Suaugusieji su Prieširdžių Virpėjimu. Clin. J. Am. Soc. Nephrol. 2021, 16, 05920421.

46. Brodsky, S.V.; Satoskar, A.; Hemminger, J.; Rovin, B.; Hebert, L.; Ryan, M.S.; Nadasdy, T. Antikoaguliantas-susijęs Nefropatija in Inkstai Biopsija: A Single-Center Report of 41 Cases. Inkstai Med. 2019, 1, 51–56.

47. Ha, J.T.; Neuen, B.L.; Cheng, L.P.; Jun, M.; Toyama, T.; Gallagher, M.P.; Jardine, M.J.; Sood, M.M.; Garg, A.X.; Palmer, S.C.; et al. Benefits and Harms of Oral Anticoagulant Therapy in Chronic Renal Disease: A Systematic Review and Meta-analysis. Ann. Intern. Med. 2019, 171, 181–189.

48. Brodsky, S.V.; Hebert, L.A. Anticoagulant-Related Nephropathy: Is an AKI Elephant Hiding in Plain View? J. Am. Coll. Cardiol. 2016, 68, 2284–2286.

49. Grüner-Hegge, N.; Kella, D.K.; Padmanabhan, D.; Deshmukh, A.J.; Mehta, R.; Hodge, D.; Melduni, R.M.; Greene, E.L.; Friedman, P.A. Renal Dysfunction following Direct Current Cardioversion of Atrial Fibrillation: Incidence and Risk Factors. Cardioren. Med. 2021, 11, 27–32.

50. Tomaszuk-Kazberuk, A.; Kozi ´ski, M.; Ku´zma, Ł.; Bujno, E.; Łopatowska, P.; Rogalska, E.; Dobrzycki, S.; Sobkowicz, B.; Lip, G.Y.H. Atrial fibrillation is more frequently associated with nonobstructive coronary lesions: The Bialystok Coronary Project. Pol. Arch. Intern. Med. 2020, 130, 1029–1036.

¹, Anna Tomaszuk-Kazberuk ²¹, Małgorzata Zalewska-Adamiec ¹,Hanna Bachórzewska-Gajewska ^1,3144,

1. Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15276 Bialystok, Poland; kuzma.lukasz@gmail.com (Ł.K.); annaxkurasz@gmail.com (A.K.); mzalewska5@wp.pl (M.Z.-A.); hgajewska@op.pl (H.B.-G.); slawek_dobrzycki@yahoo.com (S.D.)

2. Department of Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15276 Bialystok, Poland; a.tomaszuk@poczta.fm

3. Department of Clinical Medicine, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15276 Bialystok, Poland

4. Department of Nephrology, Dialysis and Internal Disease, Medical University of Warsaw, 1A Banacha St., 02097 Warsaw, Poland; marlenakwiatko@gmail.com