Prognostic Impact of Residual Renal Congestion at Discharge After Transcatheter Aortic Valve Implantation

IF 2.1 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2026-07-01 Epub Date: 2026-02-27 DOI:10.1016/j.cjco.2026.02.016

Yutaro Sato MD, Akihiko Sato MD, PhD, Kazuya Sakamoto MD, Yuuki Muto MD, PhD, Yu Sato MD, PhD, Tetsuro Yokokawa MD, PhD, Takeshi Shimizu MD, PhD, Tomofumi Misaka MD, PhD, Masayoshi Oikawa MD, PhD, Atsushi Kobayashi MD, PhD, Akiomi Yoshihisa MD, PhD, Yasuchika Takeishi MD, PhD

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Abstract

Background

Residual pulmonary congestion after transcatheter aortic valve implantation (TAVI) has been linked to adverse outcomes. However, whether renal congestion, assessed by intrarenal venous flow (IRVF), is associated with outcomes remains unclear.

Methods

This study enrolled 164 patients with aortic stenosis who underwent TAVI, and assessed IRVF before TAVI and at discharge (48-72 hours before discharge). The IRVF patterns were categorized as continuous (non-congestive) or discontinuous (congestive). The primary endpoint was a composite of all-cause death or heart failure rehospitalization.

Results

Before TAVI, 126 patients (76.8%) had a continuous pattern, and 38 (23.2%) had a discontinuous pattern; at discharge, the numbers were 134 (81.7%) and 30 (18.3%), respectively. Over a median follow-up of 698 days, the primary endpoint occurred in 37 patients (22.6%). A discontinuous pattern at discharge was associated with a higher incidence of events than a continuous pattern (log-rank P = 0.005), whereas the pre-TAVI IRVF pattern did not stratify risk. In an analysis of changes in IRVF patterns (continuous–continuous, continuous–discontinuous, discontinuous–continuous, and discontinuous–discontinuous), event rates were 20 of 114 (17.5%), 5 of 12 (41.7%), 4 of 20 (20.0%), and 8 of 18 (44.4%), respectively, and the risk was higher in patients discharged with a discontinuous pattern—continuous–discontinuous (hazard ratio [HR], 3.26, 95% confidence interval [CI] 1.19-8.92; P = 0.022) and discontinuous–discontinuous (HR, 2.34, 95% CI 1.08-5.37; P = 0.045)—compared with those in the continuous–continuous group.

Conclusions

A discontinuous IRVF pattern at discharge, indicating residual renal congestion after TAVI, was associated with an adverse prognosis.

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经导管主动脉瓣植入术后出院时残余肾充血对预后的影响

经导管主动脉瓣植入术（TAVI）后持续的肺充血与不良后果有关。然而，通过肾内静脉流量（IRVF）评估的肾充血是否与预后相关仍不清楚。方法本研究纳入164例经TAVI治疗的主动脉瓣狭窄患者，评估TAVI前和出院时（出院前48-72小时）的IRVF。IRVF模式分为连续型（非充血性）和不连续型（充血性）。主要终点为全因死亡或心力衰竭再住院。结果TAVI前连续型126例（76.8%），不连续型38例（23.2%）；出院时分别为134例（81.7%）和30例（18.3%）。在698天的中位随访中，37名患者（22.6%）出现了主要终点。出院时的不连续模式比连续模式与更高的事件发生率相关（log-rank P = 0.005），而tavi前的IRVF模式没有分层风险。IRVF变化的分析模式(continuous-continuous, continuous-discontinuous, discontinuous-continuous discontinuous-discontinuous),事件率20 114(17.5%),5 12(41.7%)、20(20.0%)、4和8 18(44.4%),分别和风险较高的病人出院不连续pattern-continuous-discontinuous(危险比[HR], 3.26, 95%可信区间[CI] 1.19 -8.92; P = 0.022)和discontinuous-discontinuous (HR, 2.34, 95%可信区间1.08 - -5.37;P = 0.045)，与连续-连续组比较。结论出院时IRVF模式不连续，提示TAVI术后残留肾充血，与不良预后有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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