Impact of Sex on the Risk to Develop Contrast-Induced Nephropathy after Transcatheter Aortic Valve Implantation

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Contrast-induced nephropathy (CIN) is the third most common cause of acute renal failure and is associated with increased morbidity and in-hospital mortality. Some recent studies identified female sex as a risk factor of CIN. The aim of this study was to determine the relative impact of female sex on the development and clinical outcome of CIN in patients with preexisting renal impairment after transapical transcatheter aortic valve implantation (TAVI). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> From February 2008 to February 2011, a total of 55 TAVI patients [82.4 (6.5) years] with preprocedural serum creatinine level of greater than 1.1 mg/dL were retrospectively investigated. The incidence of postprocedural CIN, lengths of intensive care unit and hospital stay, and short-term mortality among men and women were compared. Contrast-induced nephropathy was defined as a creatinine increase of greater than 0.5 mg/dL or greater than 25% from baseline within 3 days after contrast medium (CM) exposure. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The women had significantly lower body surface area [1.8 (0.18) vs 1.95 (0.17) m<jats:sup>2</jats:sup>; P = 0.002), lower hemoglobin levels [11.5 (1.3) vs 12.7 (1.6) g/dL, P &lt; 0.001], and lower estimated glomerular filtration rate [34.2 (9.7) vs 49.4 (12.3) mL/min per 1.73 m<jats:sup>2</jats:sup>, P = 0.002]. The amount of CM given was significantly higher in the women relative to body surface area [67.3 (42.5) vs 48.3 (16.6) mL/m<jats:sup>2</jats:sup>, P = 0.043]. The women received a higher number of blood cell transfusion units [4.4 (3.4) vs 2.1 (2.7) U, P = 0.006]. The frequency of CIN within 72 hours after CM exposure was significantly higher in the women (62.1% vs 26.9%, P = 0.009). A total of 31% of the women (n = 9) versus 7.7% of the men (n = 2) needed hemodialysis ( P = 0.031). Analysis of the postoperative morbidity in terms of length of intensive care unit and hospital stay revealed no significant difference between the two groups. Mortality results reached a significant difference at 60 days, with 31% (n = 9) mortality in the women compared with 7.7% (n = 2) in the men ( P = 0.031). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Women with preexisting renal impairment are at higher risk than men for CIN, with resultant higher early mortality after transapical TAVI. </jats:p></jats:sec>

Quantitative Analysis of Aortic Valve Stenosis and Aortic Root Dimensions by Three-Dimensional Echocardiography in Patients Scheduled for Transcutaneous Aortic Valve Implantation

“…An advantage of RT3D-TEE is that it can be performed at the bedside or directly before or even after prosthetic valve implantation for the evaluation of the implanted prosthesis, e.g., for identifying paravalvular regurgitation. Moreover, it is a good alternative to MDCT, particularly when it is essential to decrease the burden of contrast agent administration as in patients with compromised renal function—thereby potentially reducing the incidence of acute kidney failure [ 40 ] —as well as in patients with cardiac arrhythmia. RT3D-TEE may be performed immediately before and after procedures in the hybrid operating room [ 37 •, 41 ].…”

Influence of Gender on Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

“…The features of the included studies are shown in Tables 1 , 2 (Ref. [ 10 , 11 , 13 , 14 , 15 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]). Due to the large number of articles included and the large sample size, some trials lacked the baseline data of some men and women.…”

Kidney injury as post-interventional complication of TAVI

“…It has been demonstrated that calculating the ratio of CM volume /GFR ratio might be helpful in preventing kidney injury: a ratio of 3.9 was specified to predict kidney injury with 71% sensitivity and 80% specificity [62]. Other authors observed a possible association between a higher incidence of AKI and 30-day mortality with regard to the extensive use of CM during TAVI among high-risk patients with preexisting renal impairment [33,63]. This is in line with findings of a study in 270 TAVI patients, showing that postoperative AKI depend on the amount of contrast agent used intra-interventionally.…”