Highly calcified Suprarenal aortic atheroma associated with AKI after transcatheter aortic valve replacement
Italy: A study published in the International Journal of Cardiology has concluded that Suprarenal aortic atheroma, when highly calcified, is associated with Acute kidney injury- transcatheter aortic valve replacement or AKI-TAVR. The researchers said that patients at high risk of AKI-TAVR could be identified by Perioperative-MSCT assessment of aortic atherosclerosis and can be benefitted from higher peri-operative surveillance.
Acute kidney injury (AKI) may complicate transcatheter aortic valve replacement (TAVR). This could be related to atheroembolization associated with catheter manipulation in the supra-renal (SR) aorta.
Researchers in the present study determined the impact of SR aortic atheroma burden (SR-AAB) and composition, as well as of the aortic valve calcium score (AV-CS), measured at pre-operative multislice computed tomography (PO-MSCT), on AKI-TAVR. They subcategorized calcified plaque into three strata: low- (351–700 HU), mid- (701–1000 HU), and high‑calcium (>1000 HU, termed 1 K-plaque).
The study results could be summarised as follows:
- Researchers included 222 patients with a mean age of 83.3 ± 5.7 years. (TAVR patients).
- 42.8% were males.
- 67/222 patients constituting 30.2%, had AKI-TAVR.
- Patients developing AKI-TAVR had higher Absolute SR-AAB and %SR-AAB.
- Patients who developed AKI-TAVR had higher mid‑calcium and 1 K plaque. They had no difference in AV-CS (p = 0.691).
- There was an increased risk of AKI when the %SR-AAB is >15.0% and the %SR-calcified plaque is >7.0%.
- %SR-AAB [OR 1.12] and %SR-calcified plaque [OR 5.60] had associated with AKI-TAVR.
We identified %SR-AAB >15.0% and %SR-calcified plaque >7.0% as optimal thresholds for predicting increased risk of AKI-TAVR from 3-knots spline analyses.
The study highlighted the usefulness of 3-dimensional multislice computed tomography in pre-TAVR evaluation.
The researchers in this study found higher supra-renal aortic atheroma burden (SR-AAB) and calcified plaque in AKI patients.
Further reading:
Supra-renal aortic atheroma extent and composition predict acute kidney injury after transcatheter aortic valve replacement: A three-dimensional computed tomography study.
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