South Australian Health & Medical Research Institute, University of Adelaide (D.S., Y.K., A.D.P., S.J.N.).
Cardiovascular Investigation Unit, University of Adelaide, Royal Adelaide Hospital, Australia (S.D., J.K.M., S.G.W.).
Circ Cardiovasc Interv. 2018 Aug;11(8):e006367. doi: 10.1161/CIRCINTERVENTIONS.117.006367.
Acute kidney injury (AKI) can be a major complication of transcatheter aortic valve replacement (TAVR). Atheroembolization of debris during catheter manipulation has been considered as a potential factor causing AKI. This study investigates the impact of aortic atheroma burden on AKI post-TAVR and evaluates the potential of preoperative multislice computed tomographic (MSCT) imaging for the assessment of AKI in these patients.
Preoperative multislice computed tomographic images were analyzed in 278 patients with symptomatic severe aortic stenosis who underwent TAVR. AKI was defined as an absolute increase in serum creatinine ≥0.3 mg/dL. Aorta vessel and lumen areas in each 1-mm cross-sectional image were measured. Percent atheroma volume above (PAV) and below (PAV) renal arteries were calculated by the following formula: PAV={Σ (vessel area-lumen area)/Σ(vessel area)}×100. AKI occurred in 92 patients (33.1%) after TAVR. AKI was associated with a greater PAV above (30.4±8.2 versus 21.3±5.8%; P=0.02) but not below (28.9±7.7 versus 25.8±6.1%; P=0.41) the renal arteries. Greater PAV was associated directly with AKI severity ( P=0.008) and inversely with recovery in serum creatinine level from peak to discharge ( r=0.78; P=0.002). Multivariate analysis demonstrated that PAV was a significant predictor of AKI ( P=0.02). Receiver-operating curve analysis identified PAV >29.5% as an optimal threshold to predict AKI.
Suprarenal aortic atheroma burden is associated with the occurrence, severity, and recovery of AKI after TAVR. This highlights the utility of preoperative assessment of aortic atherosclerosis on multislice computed tomography to identify patients at high-risk for AKI.
急性肾损伤（AKI）可能是经导管主动脉瓣置换术（TAVR）的主要并发症。导管操作过程中碎片的动脉粥样硬化栓子栓塞被认为是导致 AKI 的潜在因素。本研究调查了主动脉粥样斑块负担对 TAVR 后 AKI 的影响，并评估了术前多层螺旋 CT（MSCT）成像在这些患者 AKI 评估中的潜力。
对 278 例接受 TAVR 的有症状严重主动脉瓣狭窄患者的术前多层螺旋 CT 图像进行了分析。AKI 定义为血清肌酐绝对增加≥0.3mg/dL。在每 1mm 横截面图像中测量主动脉血管和管腔面积。通过以下公式计算肾动脉以上（PAV）和以下（PAV）的粥样斑块体积百分比：PAV={Σ（血管面积-管腔面积）/Σ（血管面积）}×100。TAVR 后 92 例患者（33.1%）发生 AKI。AKI 与 PAV 以上（30.4±8.2 比 21.3±5.8%；P=0.02）而非 PAV 以下（28.9±7.7 比 25.8±6.1%；P=0.41）显著相关。较大的 PAV 与 AKI 严重程度直接相关（P=0.008），与从峰值到出院时血清肌酐水平的恢复呈负相关（r=0.78；P=0.002）。多变量分析表明，PAV 是 AKI 的显著预测因素（P=0.02）。接受者操作特征曲线分析确定 PAV＞29.5%为预测 AKI 的最佳阈值。
肾上主动脉粥样斑块负担与 TAVR 后 AKI 的发生、严重程度和恢复有关。这突出了术前多层螺旋 CT 评估主动脉粥样硬化对识别 AKI 高危患者的作用。
