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Open AccessArticle

Bedside Renal Doppler Ultrasonography and Acute Kidney Injury after TAVR

1
Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France
2
Université de Strasbourg, Pôle de Biologie, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France
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Université de Strasbourg, Département de néphrologie et dialyse, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France
4
UMR CNRS 7213 Laboratoire de Biophotonique et Pharmacologie, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(4), 905; https://doi.org/10.3390/jcm9040905
Received: 11 February 2020 / Revised: 20 March 2020 / Accepted: 21 March 2020 / Published: 25 March 2020
(This article belongs to the Section Cardiology)
Acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR) is associated with a dismal prognosis. Elevated renal resistive index (RRI), through renal Doppler ultrasound (RDU) evaluation, has been associated with AKI development and increased systemic arterial stiffness. Our pilot study aimed to investigate the performance of Doppler based RRI to predict AKI and outcomes in TAVR patients. From May 2018 to May 2019, 100 patients with severe aortic stenosis were prospectively enrolled for TAVR and concomitant RDU evaluation at our institution (Nouvel Hôpital Civil, Strasbourg University, France). AKI by serum Creatinine (sCr-AKI) was defined according to the VARC-2 definition and AKI by serum Cystatin C (sCyC-AKI) was defined as an sCyC increase of greater than 15% with baseline value. Concomitant RRI measurements as well as renal and systemic hemodynamic parameters were recorded before, one day, and three days after TAVR. It was found that 10% of patients presented with AKIsCr and AKIsCyC. The whole cohort showed higher baseline RRI values (0.76 ± 0.7) compared to normal known and accepted values. AKIsCyC had significant higher post-procedural RRI one day (Day 1) after TAVR (0.83 ± 0.1 vs. 0.77 ± 0.6, CI 95%, p = 0.005). AUC for AKIsCyC was 0.766 and a RRI cut-off value of ≥ 0.795 had the most optimal sensitivity/specificity (80/62%) combination. By univariate Cox analysis, Mehran Risk Score, higher baseline right atrial pressure at baseline >0.8 RRI values one day after TAVR (HR 6.5 (95% CI 1.3–32.9; p = 0.021) but not RRI at baseline were significant predictors of AKIsCyC. Importantly, no significant impact of baseline biological parameters, renal or systemic parameters could be demonstrated. Doppler-based RRI can be helpful for the non-invasive assessment of AKI development after TAVR. View Full-Text
Keywords: aortic stenosis; transcatheter aortic valve replacement; acute kidney injury; doppler based renal resistive index aortic stenosis; transcatheter aortic valve replacement; acute kidney injury; doppler based renal resistive index
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Peillex, M.; Marchandot, B.; Bayer, S.; Prinz, E.; Matsushita, K.; Carmona, A.; Heger, J.; Trimaille, A.; Petit-Eisenmann, H.; Jesel, L.; Ohlmann, P.; Morel, O. Bedside Renal Doppler Ultrasonography and Acute Kidney Injury after TAVR. J. Clin. Med. 2020, 9, 905.

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