SPC365

Prevalence, Predictors and Prognostic Significance of Acute Kidney Recovery following Transcatheter Aortic Valve Implantation

Session: Sessão de Posters 47 - TAVI
Speaker: Ana Isabel Pinho

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Ana Isabel Pinho; Catarina Amaral Marques; Cátia Oliveira; Luís Daniel Santos; André Cabrita; Teresa Pinho; Diana Martins; Isabel Miranda; Adelino Leite Moreira; Marta Tavares Silva; Carla Sousa; Rui André Rodrigues

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background: Diagnostic procedures, contrast agents and&nbsp;complications during Transcatheter Aortic Valve Implantation (TAVI) may adversely impact renal function; on the other hand, hemodynamic changes after TAVI including increased cardiac output and reduced afterload&nbsp;and congestion may result in acute kidney recovery (AKR). Although acute kidney injury (AKI) has been associated with poor prognosis after TAVI, limited data exists on the reverse phenomenon. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aim: To investigate the incidence, predictors and prognostic impact of AKR in TAVI patients (pts).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods: We conducted a prospective observational study that included 65 pts admitted for elective transfemoral TAVI between November 2021 and November 2023. </span></span><span style="font-size:16px"><span style="font-family:Times New Roman,Times,serif">Exclusion criteria included unwillingness to provide written consent, chronic kidney disease (CKD) with a Glomerular Filtration Rate (eGFR) &lt;25&nbsp;ml/min/1.73 m&sup2;, atrial fibrillation, non-revascularized ischemic heart disease, severe hepatic disease, active autoimmune or neoplastic disease. </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Analytical markers were systematically collected before and after TAVI. AKR was defined as a &ge;25% improvement in eGFR&nbsp;at 48 hours after TAVI. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results: A total of 65 TAVI pts (mean age 81.5&plusmn;4.9, 67.7% female, 95.4% in NYHA class &ge;II) were included; 41.5% had CKD&nbsp;with an eGFR 25-59 ml/min/1.73 m&sup2;. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">AKR was documented for 23.1%, AKI for 9.2% and unchanged kidney function (UKF) for 67.7% of the global cohort. In the univariate analysis, AKR was associated with higher pre-TAVI LVEF (p=0.048), lower eGFR at baseline (p=0.026), more CKD stage &ge;3 (p=0.024) and less chronic diuretic use (p=0.047). No significant differences were&nbsp;noted regarding demographics, echocardiographic parameters, CT aortic valve calcium score, contrast media administration or duration of procedure (Table 1). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Prevalence of post procedural intercurrences, including significant complications, was not statistically different (40% in AKR vs 58% in AKI or UKF, p=0.22). Median duration of hospitalization was similar (p=0.807), 5 days (range 2-26) for the entire cohort. At a median follow-up of 37 weeks (range 1&ndash;108), 13.3% pts in AKR group and 8% pts in UKF or AKI group experienced an adverse cardiac or cerebrovascular event (MACE); survival analysis showed no differences in this composite endpoint&nbsp;(p=0.525).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Independent predictors of AKR post-TAVI by multivariable analysis were chronic diuretic use (adjusted OR&nbsp;0.11, 95% CI&nbsp;0.02-0.76), CKD (OR 5.50, 95% CI 1.07-28.31) and baseline LVEF (OR 1.22, 95% CI 1.04-1.44). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions: Given the interplay between heart and kidney function, AKR after TAVI is likely to reflect a partial reversible cardiorenal syndrome. Patients with CKD, higher baseline LVEF and lack of pre-TAVI diuretic use were more likely to exhibit AKR. Even though AKR had no significant impact in clinical outcomes, the limited sample size warrants further studies to investigate the prognostic role of AKR after TAVI. </span></span></span></span></p>