Rates of acute kidney injury (AKI) were found to be higher in patients with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) who had more advanced extravalvular cardiac damage (EVCD), according to a study published in the Canadian Journal of Cardiology.

In this retrospective study, data from 674 patients (mean age, 82.3 ± 6.0 years; 55.7% women) with symptomatic severe AS from the Verona Valvular Heart Disease Registry were analyzed. Patients were classified according to the degree of EVCD which was determined using echocardiography.

Patients in EVCD stages 3 to 4 vs 0 to 2 were found to have higher rates of AKI (29.5% vs 11.2%, respectively; P <.001) in a dichotomized analysis. Higher EVCD stage, lower glomerular filtrate rate (GFR) at admission, and the level of contrast used were found to be independent predictors of AKI in a multivariate analysis. In addition, the stage of cardiac damage and GFR were independent predictors of acute kidney recovery (AKR).


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An association between AKI and a higher incidence of 12-month all-cause mortality was established in a multivariate analysis (hazard ratio [HR], 2.142; 95% CI, 1.082-4.239; P =.029), an impact which was significant in advanced, but not early, cardiac damage stages (P for interaction=.006). AKR was associated with improved renal function at 12 months but did not reduce adverse clinical outcomes.

Study limitations include its single-center, retrospective design, and the fact that intra- and inter-observer variability of echocardiography cannot be ruled out as a confounder in the analysis.

“Advanced EVCD is associated with a higher incidence of AKI, all-cause mortality, and adverse clinical events at 12 months,” concluded the study authors. “AKI demonstrated to negatively impact mid-term prognosis only when occurring in advanced stages of EVCD, but not in early stages. AKR did not reduce adverse clinical outcomes but was associated with an improvement of renal function at 12 months. The application of this staging system may provide an additional tool for the decision-making process in patients with severe AS.”

Reference

Pighi M, Fezzi S, Pesarini G, et al. Extravalvular cardiac damage and renal function following transcatheter aortic valve implantation for severe aortic stenosis [published online December 28, 2020]. Can J Cardiol. doi: 10.1016/j.cjca.2020.12.021