title: Prognostic value of aortic regurgitation after TAVI in patients with chronic kidney disease.
abstract: BACKGROUND
  Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) for severe aortic valve stenosis results in major haemodynamic changes. Influence of post-implant AR and aortic valve calcification on outcome in patients with chronic kidney disease (CKD) is unclear.
  
  
  METHODS
  Short-term outcome was defined as a combined 30-day endpoint, long-term outcome as survival. Post-implant AR was classified as none/mild or moderate/severe using transthoracic echocardiography. Aortic valve calcification was calculated by computed tomography. Logistic regression analyses were performed in patients with none/mild (estimated glomerular filtration rate [eGFR]≥30ml/min/1.73m(2)) and advanced (eGFR<30ml/min/1.73m(2)) CKD to evaluate predictors of outcome and post-implant AR.
  
  
  RESULTS
  TAVI was performed in 546 consecutive patients. Moderate/severe post-implant AR was the only independent predictor of the 30-day endpoint in patients with advanced (OR 7.091, 95% CI 1.144-43.962, p=0.035), but not in patients with none/mild CKD. Similarly, moderate/severe AR predicted impaired survival only in patients with advanced CKD (p<0.001). NT-proBNP (OR 1.023 per 500ng/l increase, 95% CI 1.003-1.043; p=0.026) before intervention was the only independent predictor of the 30-day endpoint in patients with none/mild CKD. Aortic valve calcification was comparable in patients with none/mild versus advanced CKD and was an independent predictor of moderate/severe post-implant AR in the overall population as well as in the subgroups with none/mild or advanced CKD.
  
  
  CONCLUSIONS
  Moderate/severe AR after TAVI predicts outcome in patients with advanced CKD, but not in patients with none/mild CKD. Aortic valve calcification is an important predictor of post-implant AR independent of kidney function.
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital, Zurich, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Possner
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital, Zurich, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Vontobel
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital, Zurich, Switzerland.
authors.forename: Thi Dan Linh
authors.initials: TD
authors.lastname: Nguyen-Kim
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Zindel
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerland.
authors.forename: Erik W
authors.initials: EW
authors.lastname: Holy
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerland.
authors.forename: Simon F
authors.initials: SF
authors.lastname: Stämpfli
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Zuber
authors.affiliation: Department of Nuclear Medicine, University Hospital, Zurich, Switzerland.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Department of Cardiac and Vascular Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerland; Faculty Mechanical and Medical Engineering, University Furtwangen, Schwenningen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Niemann
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerland. Electronic address: felix.tanner@usz.ch.
authors.forename: Felix C
authors.initials: FC
authors.lastname: Tanner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D002114:Calcinosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods
keywords: Aortic regurgitation; Aortic valve calcification; Chronic kidney disease; TAVI