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Atherosclerosis on CT Angiogram Predicts Acute Kidney Injury After Transcatheter Aortic Valve Replacement
Asha Kandathil1, Suhny Abbara1, Minna Hanna2
11 Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316.
Insights
Patients undergoing transcatheter aortic valve replacement (TAVR) with significant bilateral renal artery stenosis or severe aortic and iliac artery calcification face a higher risk of developing acute kidney injury (AKI) post-procedure.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- Acute kidney injury (AKI) is a known complication following TAVR.
- Identifying pre-procedural risk factors for AKI is crucial for patient management.
Purpose of the Study:
- To investigate the association between vascular calcification and renal artery stenosis (RAS) on pre-TAVR CT angiography (CTA) and post-procedure AKI.
- To determine if CTA findings can predict AKI risk in patients undergoing TAVR.
Main Methods:
- Retrospective cohort study of 106 patients who underwent TAVR.
- Pre-TAVR CTAs were reviewed for the presence and severity of aortic and iliac artery calcification and renal artery stenosis.
- AKI was assessed post-procedure.
- Multivariable logistic regression was used to analyze associations.
Main Results:
- AKI occurred in 20 out of 106 patients.
- Bilateral main renal artery stenosis (≥50% narrowing) was associated with significantly higher odds of post-TAVR AKI (OR, 4.84; p=0.01).
- Patients who developed AKI had significantly higher aortic and iliac arterial calcification scores (21.4 ± 5.6 vs 17.9 ± 6.7; p=0.04).
Conclusions:
- Bilateral renal artery stenosis (≥50%) and severe atherosclerotic calcification of the aorta and iliac arteries are associated with an increased likelihood of post-TAVR AKI.
- These findings highlight the importance of pre-procedural CTA assessment for predicting AKI risk in TAVR patients.
Objective:
The purpose of this study is to determine the association of vascular calcification and renal artery stenosis on CT angiogram (CTA) obtained before transcatheter aortic valve replacement (TAVR) with postprocedure acute kidney injury (AKI).
Materials And Methods:
In this single-center retrospective cohort study, 106 pre-TAVR CTAs were evaluated by two independent blinded readers. Renal artery stenosis was visually graded as less than 50% or greater than or equal to 50% luminal narrowing. Calcification of the aorta and iliac arteries was scored from 0 (no calcification) to 3 (severe calcification) and was summed to develop a calcification score. Univariate comparisons between patients who did and did not develop AKI were made for radiologic measurements. Multivariable logistic regression was used to assess association of renal artery stenosis and atherosclerotic calcification with post-TAVR AKI.
Results:
Post-TAVR AKI occurred in 20 of 106 patients. Subjects with bilateral main renal artery stenosis greater than or equal to 50% had significantly greater odds (odds ratio, 4.84; 95% CI, 1.41-16.54; p = 0.01) of developing post-TAVR AKI than did subjects with unilateral or no stenosis greater than or equal to 50% in the main renal arteries. Subjects who developed post-TAVR AKI had significantly higher aortic and iliac arterial calcification scores compared with subjects who did not develop post-TAVR AKI (mean ± SD, 21.4 ± 5.6 vs 17.9 ± 6.7; p = 0.04).
Conclusion:
AKI as a complication of TAVR is more likely to develop in patients with bilateral renal artery stenosis greater than or equal to 50% or severe atherosclerotic calcification of the aorta and iliac arteries.
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