{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:26:19Z","timestamp":1789683979905,"version":"4.0.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Contrast-associated acute kidney injury (CA-AKI) is frequently associated with adverse outcomes. Renal perfusion gradient is central to glomerular filtration. While renal vasoconstriction can partially compensate low-output-associated impairment of the renal perfusion gradient, venous congestion cannot be compensated. We hypothesized that congestion is a stronger predictor of CA-AKI than low output in cardiovascular diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      An all-comer single-center cohort of 3,126 cases undergoing coronary angiography with simultaneous right heart catheterization was analyzed. Patients were divided into four categories: congested [right atrial pressure (RAP) &amp;gt;10\u2005mmHg and cardiac index (CI) &amp;gt;=2.2\u2005L\/min\/m\n                      <jats:sup>2<\/jats:sup>\n                      ], low output (RAP\u2009&amp;lt;=\u200910\u2005mmHg and CI: &amp;lt;2.2\u2005L\/min\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), combined (RAP\u2009&amp;gt;\u200910\u2005mmHg and CI &amp;lt;2.2\u2005L\/min\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), and control (CI\u2009&amp;gt;=\u20092.2\u2005L\/min\/m\n                      <jats:sup>2<\/jats:sup>\n                      and RAP\u2009&amp;lt;=\u200910\u2005mmHg). The average age of patients was 74 years. CA-AKI occurred in 19% of patients overall. The incidence was highest among patients with congestion, who showed a significantly greater risk compared to controls (24% vs. 15%; Hazard Ratio (HR): 1.49,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001), whereas low-output patients showed only a trend towards increased risk (20% vs. 15%; HR: 1.22,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.059). In multivariate analysis including the MEHRAN Score, only congestion but not low output was independently associated with AKI (HR for 5\u2005mmHg increase in RAP: 1.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034; HR for CI: 1.00,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.936).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Venous congestion is independently associated with CA-AKI and is a stronger predictor of CA-AKI than low cardiac output.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1797135","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:37:52Z","timestamp":1781501872000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Congestion, but not low cardiac output, is independently associated with acute kidney injury following contrast agent exposure"],"prefix":"10.3389","volume":"13","author":[{"given":"Jean Marc","family":"Haurand","sequence":"first","affiliation":[{"name":"Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University","place":["D\u00fcsseldorf, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elric","family":"Zweck","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University","place":["D\u00fcsseldorf, 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Germany"]},{"name":"Cardiovascular Research Institute D\u00fcsseldorf, Medical Faculty, Heinrich Heine University","place":["D\u00fcsseldorf, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Ruschitzka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Westenfeld","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University","place":["D\u00fcsseldorf, Germany"]},{"name":"Cardiovascular Research Institute D\u00fcsseldorf, Medical Faculty, Heinrich Heine University","place":["D\u00fcsseldorf, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Polzin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology, and Vascular 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