The impact of preprocedural pulmonary artery systolic pressure on acute kidney injury related to transcatheter aortic valve replacement.

Abstract

Introduction: Transcatheter aortic valve replacement (TAVR) may lead to acute kidney injury (AKI), potentially associated with an unfavorable prognosis in the short and long term.

Aim: The goal of this analysis was to explore the predictive potential of pulmonary artery systolic pressure (PASP) for the evolution of AKI following TAVR in an effort to more reliably establish potential risk factors for this expanding population.

Material and methods: This single-center retrospective analysis included subjects (n = 90) with severe aortic stenosis (AS) undergoing TAVR. Subjects were categorized into two groups based on the evolution of TAVR-associated AKI. Logistic regression analysis was harnessed to determine predictors of TAVR-associated AKI.

Results: The overall incidence of TAVR-associated AKI was found to be 25.6%. Regarding the baseline PASP values, the TAVR-associated AKI(+) group demonstrated higher PASP values compared with those without AKI (55.4 ±14.0 vs. 37.1 ±16.3 mm Hg, p < 0.001). Multivariate logistic regression analysis suggested EuroSCORE (OR = 1.238, 95% CI: 1.093-1.401, p = 0.001), PASP (OR = 1.076, 95% CI: 1.017-1.139, p = 0.011), and hypertension (OR = 3.544, 95% CI: 1.438-5.738, p = 0.017) as independent AKI predictors. ROC curve analysis suggested a PASP value of > 39 mm Hg as an AKI predictor in the post-TAVI setting (with specificity and sensitivity of values of 70.7% and 82.6%, respectively).

Conclusions: PASP at baseline was found to be independently associated with TAVR-associated AKI evolution. In other words, a higher PASP value in the pre-TAVI setting might serve as a potential marker of AKI evolution following TAVI.