Evaluating the Association between Contrast Medium Dosage and Acute Kidney Injury in Transcatheter Aortic Valve Replacement Using Different Predictive Models

Abstract

Recent studies have suggested that contrast medium (CM) volume is associated with acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR). However, in a high-risk elderly TAVR population, the prognostic value and ideal threshold of CM dosage for AKI is unclear. Data of 532 successive TAVR patients (age 81.1 ± 6.8 years, EuroSCORE II 4.8% ± 6.0%) were therefore retrospectively analyzed. Based on a recently published formula, the renal function (preprocedural serum creatinine: SCr) corrected ratio of CM and body weight (CM*SCr/BW) was calculated to determine the risk of postprocedural contrast-associated AKI. AKI occurred in 94 patients (18.3%) and significantly increased 1-year all-cause mortality (23.4% vs. 13.1%; p = 0.001). A significant correlation between AKI and 30-day as well as 1-year all-cause mortality was observed (p = 0.001; p = 0.007). However, no association between CM dosage or the CM*SCr/BW ratio with the occurrence of AKI was seen (p = 0.968; p = 0.442). In our all-comers, all-access cohort, we found no relationship between CM dosage, or the established risk ratio model and the occurrence of postprocedural AKI. Further research needs to be directed towards different pathophysiological causes and preventive measures as AKI impairs short- and long-term survival.

Acute Kidney Injury Following Transcatheter Aortic Valve Implantation: Association with Contrast Media Dosage and Contrast Media Based Risk Predication Models

“…The relationship between CM volume and TAVI-related AKI is also controversial. In several previous studies there was no significant difference in the volume of CM delivered during TAVI, between AKI+ patients and AKI− patients, nor between CM dose and post-procedural AKI [ 2 , 4 , 5 , 8 , 16 ]. Conversely, other studies described higher dosages of CM in AKI+ patients compared to AKI, and an association between the volume of CM delivered during TAVI and the subsequent development of AKI [ 6 , 9 , 10 , 25 , 26 ].…”

“…For instance, Zivcovic et al introduced an AKI risk calculator that was meant to be utilized prior to TAVI and therefore did not include a CM component [ 27 ]. As in this study, several previous studies tested the effectiveness of CM-based, non-TAVI dedicated risk models in predicting AKI following TAVI [ 6 , 15 , 16 , 24 , 26 , 50 ]. In our study, none of the CM-based risk models we tested independently predicted post-TAVI AKI.…”

“…Additionally, when possible, we calculated a modified version of the risk model in which the CM volume was excluded. The following AKI risk prediction models were tested: (1) CM volume (in ml) divided by the creatinine clearance (CrCl) (in mL/min/1.73 m 2 ) [ 11 ], (2) CM (in ml) × Serum Creatinine (SCr) (in mg/dL)/Body weight (BW) (in kg) [ 10 ], (3) CM (in ml) × SCr (in mg/dL)/body mass index (BMI) (in kg/m 2 ) [ 16 ], (4) The Mehran risk score was calculated by adding the following: congestive heart failure, 5 points; hypotension, 5 points; intra-aortic balloon pump use, 5 points; age over 75 years, 4 points; anemia, 3 points; diabetes mellitus, 3 points; CM volume, 1 point per 100 mL; eGFR, 2 points for 40–59 mL/min/1.73 m 2 , 4 points for 20–39 mL/min/1.73 m 2 and 6 points for <20 mL/min/1.73 m 2 ) [ 13 ], and (5). The CR4EATME3AD3 model was calculated as follows: contrast volume > 200 mL, 2 points; eGFR < 60 mL/min/1.73 m 2 , 4 points; emergency procedure, 2 points; age > 70 years, 2 points; hypotension, 2 points; previous myocardial infarction, 2 points; left ventricular ejection fraction < 45%, 3 points; anemia, 2 points; diabetes mellitus, 3 points [ 14 ].…”

“…Risk assessment tools, incorporating CM volume, have proved useful in predicting the development of AKI following percutaneous coronary procedures [ 11 , 12 , 13 , 14 ]. However, the utility of such risk models in predicting post-TAVI AKI is less established [ 6 , 15 , 16 ].…”

Aortic Annular Sizing Using Novel Software in Three-Dimensional Transesophageal Echocardiography for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

“…Recently, MDCT is routinely used as the reference standard imaging modality in assessment of the aortic annulus for pre-TAVR procedure. However, MDCT has its own radiation exposure limits, higher costs, and contraindications to kidney failure and contrast allergy that are not appropriate for screening or repetitive control, particularly with the expansion of younger individual patients at lower surgical risk [ 7 , 20 , 21 , 55 ].…”