Baylor University Medical Center Proceedings October 2017 - 408

Table 3. Urinary metabolites by arterial access
Femoral

Radial

P value

0.71 ± 1.20

0.67 ± 1.12

0.89

-2.30 (-2.30 to +4.35)

0.55 (-2.30 to +3.74)

0.25

4.69 ± 1.31

4.48 ± 1.22

0.54

6.29 (5.21 to 9.69)

6.06 (4.07 to 6.89)

0.07

8.80 ± 0.78

8.41 ± 1.07

0.11

0.99 ± 0.93

0.83 ± 0.87

0.48

Preprocedure
HSP27: mean ± SD
Thioredoxin: median (range)
Taurine: mean ± SD
Talose: median (range)
Sulfuric acid: mean ± SD
Postprocedure
HSP27: mean ± SD

Urinary biomarkers of acute vascular injury are
a future tool to detect dynamic changes occurring at
the cellular level. Despite very diﬀerent patterns of
arterial puncture and wire exchanges involving different lengths and regions of the aorta, we were unable to ﬁnd signiﬁcant diﬀerences in the molecules
chosen between TRA and TFA approaches. Given
the diﬀerences in clinical outcomes between these
methods, future studies should consider broader
arrays of markers with the aim of discovering new
diagnostic or therapeutic targets for vascular or
kidney injury.

Rao SV, Bernat I, Bertrand OF. Clinical update: Remaining challenges and opportunities for improvement in perTaurine: mean ± SD
4.82 ± 1.35
4.56 ± 1.12
0.41
cutaneous transradial coronary procedures. Eur Heart J
Talose: median (range)
6.49 (5.58 to 11.70)
6.24 (4.52 to 9.62)
0.12
2012;33(20):2521-2526.
2. Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi
Sulfuric acid: mean ± SD
8.58 ± 0.68
8.44 ± 0.71
0.44
S, Zaro T, Rubartelli P, Briguori C, Andò G, Repetto A,
Delta (post - pre)
Limbruno U, Cortese B, Sganzerla P, Lupi A, Galli M,
Colangelo S, Ierna S, Ausiello A, Presbitero P, Sardella G,
HSP27: mean ± SD
0.29 ± 1.08
0.16 ± 0.80
0.61
Varbella F, Esposito G, Santarelli A, Tresoldi S, Nazzaro M,
0 (-6.17 to +3.29)
0 (-5.99 to +5.92)
0.33
Thioredoxin: median (range)
Zingarelli A, de Cesare N, Rigattieri S, Tosi P, Palmieri C,
Taurine: mean ± SD
0.14 ± 0.89
0.08 ± 0.63
0.76
Brugaletta S, Rao SV, Heg D, Rothenbühler M, Vranckx
P, Jüni P; MATRIX Investigators. Radial versus femoral
Talose: median (range)
0.19 (-2.14 to +5.20) 0.11 (-0.84 to +2.89)
0.72
access in patients with acute coronary syndromes undergoSulfuric acid: mean ± SD
0.22 ± 0.84
0.04 ± 1.19
0.34
ing invasive management: a randomised multicentre trial.
Lancet 2015;385(9986):2465-2476.
HSP indicates heat shock protein. The values presented in the table are natural logarithmic values.
3. Schussler JM, Vasudevan A, von Bose LJ, Won JI, McCullough PA. Comparative eﬃcacy of transradial versus transfemoral
Acute infections and diseases of the liver and biliary tree were
approach for coronary angiography and percutaneous coronary intervention. Am J Cardiol 2016;118(4):482-488.
also noted to increase the production of taurine (20). It was
4. Cortese B, Sciahbasi A, Sebik R, Rigattieri S, Alonzo A, Silva-Orrego P,
reported that increased urinary excretion of taurine is found in
Belloni F, Seregni RG, Giovannelli F, Tespili M, Ricci R, Berni A.
patients with poorly controlled diabetes or ketoacidosis (21).
Comparison of risk of acute kidney injury after primary percutaneous
In our study, we did not ﬁnd any signiﬁcant diﬀerences in the
coronary interventions with the transradial approach versus the translevels of taurine before and after the procedure; however, we did
femoral approach (from the PRIPITENA urban registry). Am J Cardiol
2014;114(6):820-825.
identify gender-speciﬁc diﬀerences, with higher values of taurine
5. Yatim N, Cullen S, Albert ML. Dying cells actively regulate adaptive
in men. By a partial least squares-discriminant analysis, an eximmune responses. Nat Rev Immunol 2017;17(4):262-275.
ploratory study indicated that increased excretion of talose was
6. Diercks DB, Owen K, Tolstikov V, Sutter M. Urinary metabolomic analyassociated with renal injury in heart failure patients. Increased
sis for the identiﬁcation of renal injury in patients with acute heart failure.
excretion of sulfuric acid in heart failure was believed to be due
Acad Emerg Med 2012;19(1):18-23.
to the oxidative stress in patients' renal tubules (20). We found
7. Vidyasagar A, Wilson NA, Djamali A. Heat shock protein 27 (HSP27):
biomarker of disease and therapeutic target. Fibrogenesis Tissue Repair
a signiﬁcant increase in talose postprocedure, with higher levels
2012;5(1):7.
among diabetics. In our study, patients with dyslipidemia had
8. Tobino K, Muso E, Iwasaki Y, Yonemoto S, Kasuno K, Tsukamoto T,
increased levels of sulfuric acid in their urine preprocedure.
Nakamura H, Tomino Y. Gender- and disease-speciﬁc urinary thioreHowever, no diﬀerences in their levels were found before and
doxin in chronic kidney disease patients with or without type 2 diabetic
after the procedure between the two arterial approaches.
nephropathy. Nephrology (Carlton) 2015;20(5):368-374.
9. Okusa MD, Davenport A. Reading between the (guide)lines-the
This was a prospective study in which urine was collected at
KDIGO practice guideline on acute kidney injury in the individual
speciﬁed time intervals and patients were followed diligently for
patient. Kidney Int 2014;85(1):10.1038/ki.2013.378.
30 days postprocedure. However, this study included patients
10. Sweetman L, Ashcraft P, Bennett-Firmin J. Quantitative organic acids
of a single interventionist from one facility, and almost all of
in urine by two dimensional gas chromatography/time of ﬂight mass
the patients included in the study were admitted for an elective
spectrometry(GCxGC-TOFMS). Methods Mol Biol 2016;1378:183-
197.
procedure. We also did not attempt to randomize the patients
11. Niesser M, Koletzko B, Peissner W. Determination of creatinine in human
to the radial or femoral access route. We acknowledge this as a
urine with ﬂow injection tandem mass spectrometry. Ann Nutr Metab
limitation of the study, as this could have introduced a selection
2012;61(4):314-321.
bias and prevents generalizability. We recognize that this was
12. Guest PC, Gottschalk MG, Bahn S. Proteomics: improving biomarker
not a study on established AKI biomarkers but an exploratory
translation to modern medicine? Genome Med 2013;5(2):17.
eﬀort focusing on novel metabolites of vascular injury and renal
13. Devarajan P, Williams LM. Proteomics for biomarker discovery in acute
kidney injury. Semin Nephrol 2007;27(6):637-651.
damage.

Thioredoxin: median (range)

408

-2.30 (-2.30 to +4.45) -2.30 (-2.30 to +3.62)

0.01

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