Dominik Kylies1,2, Sandra Freitag-Wolf3, Florian Fulisch4, Hatim Seoudy4,5, Thorsten Feldkamp1, Derk Frank6,7, Christian Kuhn4, Lars Philipp Kihm8, Thomas Pühler9, Georg Lutter9, Astrid Dempfle3, Norbert Frey4,5. 1. Department of Internal Medicine IV, Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany. 2. Present Address: Department of Internal Medicine III, Nephrology, Rheumatology and Endocrinology, University Hospital Hamburg (UKE), Hamburg, Germany. 3. Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany. 4. Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany. 5. DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany. 6. Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany. derk.frank@uksh.de. 7. DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany. derk.frank@uksh.de. 8. Department of Internal Medicine I, University Hospital Heidelberg, Heidelberg, Germany. 9. Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
Abstract
BACKGROUND: Chronic kidney disease as well as acute kidney injury are associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). However, little is known about the prognostic implications of an improvement in renal function after TAVR. METHODS: Renal improvement (RI) was defined as a decrease in postprocedural creatinine in μmol/l of ≥1% compared to its preprocedural baseline value. A propensity score representing the likelihood of RI was calculated to define patient groups which were comparable regarding potential confounders (age, sex, BMI, NYHA classification, STS score, log. EuroSCORE, history of atrial fibrillation/atrial flutter, pulmonary disease, previous stroke, CRP, creatinine, hsTNT and NT-proBNP). The cohort was stratified into 5 quintiles according to this propensity score and the survival time after TAVR was compared within each subgroup. RESULTS: Patients in quintile 5 (n = 93) had the highest likelihood for RI. They were characterized by higher creatinine, lower eGFR, higher NYHA class, higher NT-proBNP, being mostly female and having shorter overall survival time. Within quintile 5, patients without RI had significantly shorter survival compared to patients with RI (p = 0.002, HR = 0.32, 95% CI = [0.15-0.69]). There was no survival time difference between patients with and without RI in the whole cohort (p = 0.12) and in quintiles 1 to 4 (all p > 0.16). Analyses of specific subgroups showed that among patients with NYHA class IV, those with RI also had a significant survival time benefit (p < 0.001, HR = 0.15; 95%-CI = [0.05-0.44]) compared to patients without RI. CONCLUSIONS: We here describe a propensity score-derived specific subgroup of patients in which RI after TAVR correlated with a significant survival benefit.
BACKGROUND: Chronic kidney disease as well as acute kidney injury are associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). However, little is known about the prognostic implications of an improvement in renal function after TAVR. METHODS: Renal improvement (RI) was defined as a decrease in postprocedural creatinine in μmol/l of ≥1% compared to its preprocedural baseline value. A propensity score representing the likelihood of RI was calculated to define patient groups which were comparable regarding potential confounders (age, sex, BMI, NYHA classification, STS score, log. EuroSCORE, history of atrial fibrillation/atrial flutter, pulmonary disease, previous stroke, CRP, creatinine, hsTNT and NT-proBNP). The cohort was stratified into 5 quintiles according to this propensity score and the survival time after TAVR was compared within each subgroup. RESULTS: Patients in quintile 5 (n = 93) had the highest likelihood for RI. They were characterized by higher creatinine, lower eGFR, higher NYHA class, higher NT-proBNP, being mostly female and having shorter overall survival time. Within quintile 5, patients without RI had significantly shorter survival compared to patients with RI (p = 0.002, HR = 0.32, 95% CI = [0.15-0.69]). There was no survival time difference between patients with and without RI in the whole cohort (p = 0.12) and in quintiles 1 to 4 (all p > 0.16). Analyses of specific subgroups showed that among patients with NYHA class IV, those with RI also had a significant survival time benefit (p < 0.001, HR = 0.15; 95%-CI = [0.05-0.44]) compared to patients without RI. CONCLUSIONS: We here describe a propensity score-derived specific subgroup of patients in which RI after TAVR correlated with a significant survival benefit.
Authors: Marcello Tonelli; Natasha Wiebe; Bruce Culleton; Andrew House; Chris Rabbat; Mei Fok; Finlay McAlister; Amit X Garg Journal: J Am Soc Nephrol Date: 2006-05-31 Impact factor: 10.121
Authors: Nicolo Piazza; Peter Wenaweser; Menno van Gameren; Thomas Pilgrim; Apostolos Tzikas; Apostolos Tsikas; Amber Otten; Rutger Nuis; Yoshinobu Onuma; Jin Ming Cheng; A Pieter Kappetein; Eric Boersma; Peter Juni; Peter de Jaegere; Stephan Windecker; Patrick W Serruys Journal: Am Heart J Date: 2010-02 Impact factor: 4.749
Authors: Iris E Beldhuis; Peder L Myhre; Brian Claggett; Kevin Damman; James C Fang; Eldrin F Lewis; Eileen O'Meara; Bertram Pitt; Sanjiv J Shah; Adriaan A Voors; Marc A Pfeffer; Scott D Solomon; Akshay S Desai Journal: JACC Heart Fail Date: 2019-01 Impact factor: 12.035
Authors: David M Shahian; Sean M O'Brien; Giovanni Filardo; Victor A Ferraris; Constance K Haan; Jeffrey B Rich; Sharon-Lise T Normand; Elizabeth R DeLong; Cynthia M Shewan; Rachel S Dokholyan; Eric D Peterson; Fred H Edwards; Richard P Anderson Journal: Ann Thorac Surg Date: 2009-07 Impact factor: 4.330