Author + information
- Received November 14, 2012
- Revision received January 16, 2013
- Accepted February 2, 2013
- Published online May 1, 2013.
- Masanori Yamamoto, MD, PhD⁎,
- Kentaro Hayashida, MD, PhD†,
- Gauthier Mouillet, MD⁎,
- Bernard Chevalier, MD†,
- Kentaro Meguro, MD, PhD⁎,
- Yusuke Watanabe, MD†,
- Jean-Luc Dubois-Rande, MD, PhD‡,§,
- Marie-Claude Morice, MD†,
- Thierry Lefèvre, MD†,⁎ ( and )
- Emmanuel Teiger, MD, PhD⁎,§,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Emmanuel Teiger, Department of Interventional Cardiology, AP-HP, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Creteil, France
- ↵⁎Dr. Thierry Lefèvre, Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, 91300 Massy, France
Objectives This study sought to assess whether the volume of contrast media (CM) influences the occurrence of acute kidney injury (AKI) following transcatheter aortic valve implantation (TAVI).
Background The volume of CM has been shown to be associated with increasing risk of AKI; however, in a high-risk elderly TAVI population, the predictive value and optimal threshold of CM dose on AKI remain uncertain.
Methods Data of 415 consecutive transfemoral TAVI patients (age 83.6 ± 6.8 years, logistic EuroSCORE 23.0 ± 12.2%) were analyzed. AKI was defined by Valve Academic Research Consortium criteria. Based on a previous formula, the ratio of CM to serum creatinine (SCr) and body weight (BW) (CM × SCr/BW) was calculated as defining the degree of CM use. The association between CM dose and incidence of AKI, as well as predictive factors and prognosis of AKI, were investigated.
Results AKI occurred in 63 patients (15.2%). Cumulative 1-year mortality showed significant differences between the AKI and non-AKI groups (47.9% vs. 15.7%, p < 0.001). Mean CM × SCr/BW ratio was higher in the AKI group than in the non-AKI group (4.1 ± 2.9 vs. 2.9 ± 1.6, p < 0.001). By multivariate analysis, CM × SCr/BW per 1.0 increase, ejection fraction <40%, and transfusion were associated with the occurrence of AKI (odds ratio [OR]: 1.16; 95% confidence interval [CI]: 1.03 to 1.20; p = 0.017, OR: 3.01; 95% CI: 1.49 to 5.00; p = 0.001, OR: 2.73; 95% CI: 1.54 to 6.15; p = 0.001, respectively). A threshold value of CM × SCr/BW for predicting AKI was statistically identified as 2.7.
Conclusions Although mechanisms of AKI following TAVI are multifactorial, the present study identified a relationship between CM dose increment and high prevalence of AKI. Therapeutic efforts not to exceed the threshold value may reduce the risk of AKI.
Dr. Hayashida is a proctor for transfemoral TAVI for Edwards Lifesciences. Dr. Chevalier is a consultant for Abbott Laboratories, Medtronic, and Terumo. Dr. Lefèvre is a proctor for transfemoral TAVI for Edwards Lifesciences; is a consultant for Symetis and DirectFlow Medical; is a co-principal investigator for the DirectFlow Medical study; and is the French principal investigator for the Reprise II study. Dr. Teiger is a proctor for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 14, 2012.
- Revision received January 16, 2013.
- Accepted February 2, 2013.
- American College of Cardiology Foundation