Abstract 15023: Atherosclerosis Burden of the Aortic Valve and Aorta and Risk of Acute Kidney Injury After Transcatheter Aortic Valve Implantation
Background: Transcatheter aortic valve implantation (TAVI) involves both the manoeuvring of large catheters across a severely diseased aorta and the deployment of a prosthesis within a calcified aortic valve which may dislodge cholesterol crystals. Atheroembolic renal disease may be one of the pathophysiological mechanisms of acute kidney injury (AKI) complicating TAVI.
Objective: To investigate the association between atherosclerotic burden and plaque characteristics of the aortic valve and thoracic aorta, evaluated with multi-detector computed tomography (MDCT), and the occurrence of AKI following TAVI.
Methods: Aortic valve calcification, atherosclerosis burden and plaque characteristics of the descending thoracic aorta (DTA) were analysed in pre-procedural MDCT data of 210 TAVI patients (age 81±7.1 years, 51.4% men). The atherosclerotic burden was defined as the proportion of DTA segments with atherosclerosis (Figure). MDCT data were correlated with the occurrence of post-procedural AKI (defined using the Valve Academic Research Consortium-2 criteria) in a multivariate logistic regression model.
Results: Post-procedural AKI occurred in 51 patients (24.3%). In patients with AKI the burden of overall (100 [83.3-100]% vs. 80 [50-80]%, p<0.001) and of non-calcified atherosclerosis (50 [28.6-80.0]% vs. 16.7 [0-33.3]%, p<0.001) and the maximum plaque thickness (5.4±1.8mm vs. 4.3±1.4mm, p<0.001) were larger as compared to patients without AKI. These parameters remained independently associated with AKI after adjusting for baseline creatinine level, logistic EuroSCORE and procedural access.
Conclusions: In patients undergoing TAVI the extent and severity of the atherosclerotic burden of the DTA is independently associated with the occurrence of post-procedural AKI.
Following the posterior intercostal arteries as landmarks, the DTA was divided in segments to measure maximal plaque thickness and categorization for atherosclerosis type.
Author Disclosures: P. van Rosendael: None. V. Kamperidis: Research Grant; Significant; European Association of Cardiovascular Imaging research grant, Hellenic Foundation of Cardiology research grant. F. van der Kley: None. S. Katsanos: Research Grant; Significant; Hellenic Foundation of Cardiology research grant. I. Al Amri: None. M. Regeer: None. A. de Weger: None. N. Ajmone Marsan: None. J. Bax: None. V. Delgado: Speakers Bureau; Modest; Abbott Vascular.
- © 2014 by American Heart Association, Inc.