Related Experiment Video
Updated: Sep 21, 2025
Investigating Aortic Valve Calcification via Isolation and Culture of T Lymphocytes using Feeder Cells from Irradiated Buffy Coat
Published on: February 4, 2021
Cystatin C in risk prediction after transcatheter aortic valve replacement: a retrospective analysis
Kensuke Kuwabara1,2, Kan Zen2, Masaki Yashige2
1Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Insights
Chronic kidney disease (CKD) classification using cystatin C-based estimated glomerular filtration rate (eGFR) better predicts outcomes after transcatheter aortic valve replacement (TAVR) than creatinine-based eGFR. Advanced CKDCys stages indicate higher risks.
Area of Science:
- Nephrology
- Cardiology
- Medical Diagnostics
Background:
- Chronic kidney disease (CKD) is a significant comorbidity in patients undergoing transcatheter aortic valve replacement (TAVR).
- Current CKD classification relies on creatinine-based estimated glomerular filtration rate (eGFRCr), which may underestimate kidney dysfunction.
- Cystatin C-based eGFR (eGFRCys) offers an alternative marker for kidney function assessment.
Purpose of the Study:
- To evaluate the prognostic value of CKD classification using cystatin C-based eGFR (CKDCys) compared to creatinine-based eGFR (CKDCr) in patients undergoing TAVR.
- To determine if CKDCys classification provides superior risk prediction for major adverse cardiovascular and cerebrovascular events (MACCE) post-TAVR.
Main Methods:
- Retrospective analysis of 219 patients with severe aortic stenosis who underwent TAVR.
- Pre-operative CKDCr and CKDCys classifications were assessed for their association with 2-year MACCE.
- MACCE included all-cause mortality, myocardial infarction, stroke, and heart failure rehospitalization.
Main Results:
- A significant proportion of patients (49.0%) were reclassified to a lower CKD stage based on eGFRCys compared to eGFRCr.
- CKDCys classification, unlike CKDCr, significantly stratified the risk of 2-year MACCE (P = 0.003).
- Multivariate analysis identified CKDCys stage 3b (HR = 4.37) and stage 4+5 (HR = 3.72) as independent predictors of MACCE.
Conclusions:
- CKDCys classification demonstrates superior risk assessment compared to CKDCr in TAVR patients.
- Advanced CKDCys stages (3b and 4+5) are significantly associated with adverse cardiovascular and cerebrovascular outcomes post-TAVR.
- Utilizing eGFRCys for CKD staging may improve pre-procedural risk stratification in the TAVR population.
Aims:
No study has evaluated the prognostic value of the chronic kidney disease (CKD) classification by cystatin C-based estimated glomerular filtration rate (eGFR) (CKDCys classification) in patients undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare the prognostic value of CKDCys classification and CKD classification by creatinine-based eGFR (CKDCr classification) in risk prediction after TAVR.
Methods And Results:
We retrospectively analysed consecutive 219 patients with symptomatic severe aortic stenosis who underwent TAVR at our institute between December 2016 and June 2019. Pre-operative CKDCr and CKDCys classifications were evaluated for their prognostic value of 2-year major adverse cardiovascular and cerebrovascular events (MACCE) after TAVR. MACCE was defined as the composite of all-cause mortality, non-fatal myocardial infarction, stroke, and rehospitalization for worsening congestive heart failure. Participants had a median age of 86.0 years and were predominantly female (76.9%). In 96.6% of the cases, TAVR was performed using transfemoral access. The median creatinine-based eGFR (52.85 mL/min/1.73 m2 ) was higher than the cystatin C-based eGFR (41.50 mL/min/1.73 m2 ). Downward reclassification in CKD stages based on eGFRCys was observed in 49.0% of patients. During a median follow-up period of 575.5 (interquartile range: 367.0-730.0) days, 58 patients presented with MACCE. CKDCys classification, but not CKDCr classification, significantly stratified the risk of 2-year MACCE in patients after TAVR by log-rank test (P = 0.003). In multivariate Cox regression analysis, only CKDCys stage 3b [hazard ratio (HR) = 4.37; 95% confidence interval (CI): 1.28-14.91; P = 0.019] and CKDCys stage 4 + 5 (HR = 3.72; 95% CI: 1.06-12.99; P = 0.040) were significant predictors of MACCE after adjustment for potential confounders.
Conclusions:
The CKDCys classification could better assess the risk than the CKDCr classification in patients undergoing TAVR. CKDCys stage 3b and stage 4 + 5 correlated with adverse outcomes.
