Abstract

OBJECTIVE. The purpose of this study is to determine the association of vascular calcification and renal artery stenosis on CT angiogram (CTA) obtained before transcatheter aortic valve replacement (TAVR) with postprocedure acute kidney injury (AKI). MATERIALS AND METHODS. In this single-center retrospective cohort study, 106 pre-TAVR CTAs were evaluated by two independent blinded readers. Renal artery stenosis was visually graded as less than 50% or greater than or equal to 50% luminal narrowing. Calcification of the aorta and iliac arteries was scored from 0 (no calcification) to 3 (severe calcification) and was summed to develop a calcification score. Univariate comparisons between patients who did and did not develop AKI were made for radiologic measurements. Multivariable logistic regression was used to assess association of renal artery stenosis and atherosclerotic calcification with post-TAVR AKI. RESULTS. Post-TAVR AKI occurred in 20 of 106 patients. Subjects with bilateral main renal artery stenosis greater than or equal to 50% had significantly greater odds (odds ratio, 4.84; 95% CI, 1.41–16.54; p = 0.01) of developing post-TAVR AKI than did subjects with unilateral or no stenosis greater than or equal to 50% in the main renal arteries. Subjects who developed post-TAVR AKI had significantly higher aortic and iliac arterial calcification scores compared with subjects who did not develop post-TAVR AKI (mean ± SD, 21.4 ± 5.6 vs 17.9 ± 6.7; p = 0.04). CONCLUSION. AKI as a complication of TAVR is more likely to develop in patients with bilateral renal artery stenosis greater than or equal to 50% or severe atherosclerotic calcification of the aorta and iliac arteries.

Original languageEnglish (US)
Pages (from-to)677-683
Number of pages7
JournalAmerican Journal of Roentgenology
Volume211
Issue number3
DOIs
StatePublished - Sep 1 2018

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Acute Kidney Injury
Atherosclerosis
Angiography
Renal Artery Obstruction
Iliac Artery
Aorta
Vascular Calcification
Transcatheter Aortic Valve Replacement
Renal Artery
Pathologic Constriction
Cohort Studies
Retrospective Studies
Logistic Models
Odds Ratio

Keywords

  • Acute kidney injury
  • Atherosclerosis
  • CT angiogram
  • Renal artery stenosis
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Atherosclerosis on CT angiogram predicts acute kidney injury after transcatheter aortic valve replacement. / Kandathil, Asha; Abbara, Suhny; Hanna, Minna; Minhajuddin, Abu; Wehrmann, Lauren; Merchant, Akeel M.; Mills, Richard; Fox, Amanda A.

In: American Journal of Roentgenology, Vol. 211, No. 3, 01.09.2018, p. 677-683.

Research output: Contribution to journalArticle

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title = "Atherosclerosis on CT angiogram predicts acute kidney injury after transcatheter aortic valve replacement",
abstract = "OBJECTIVE. The purpose of this study is to determine the association of vascular calcification and renal artery stenosis on CT angiogram (CTA) obtained before transcatheter aortic valve replacement (TAVR) with postprocedure acute kidney injury (AKI). MATERIALS AND METHODS. In this single-center retrospective cohort study, 106 pre-TAVR CTAs were evaluated by two independent blinded readers. Renal artery stenosis was visually graded as less than 50{\%} or greater than or equal to 50{\%} luminal narrowing. Calcification of the aorta and iliac arteries was scored from 0 (no calcification) to 3 (severe calcification) and was summed to develop a calcification score. Univariate comparisons between patients who did and did not develop AKI were made for radiologic measurements. Multivariable logistic regression was used to assess association of renal artery stenosis and atherosclerotic calcification with post-TAVR AKI. RESULTS. Post-TAVR AKI occurred in 20 of 106 patients. Subjects with bilateral main renal artery stenosis greater than or equal to 50{\%} had significantly greater odds (odds ratio, 4.84; 95{\%} CI, 1.41–16.54; p = 0.01) of developing post-TAVR AKI than did subjects with unilateral or no stenosis greater than or equal to 50{\%} in the main renal arteries. Subjects who developed post-TAVR AKI had significantly higher aortic and iliac arterial calcification scores compared with subjects who did not develop post-TAVR AKI (mean ± SD, 21.4 ± 5.6 vs 17.9 ± 6.7; p = 0.04). CONCLUSION. AKI as a complication of TAVR is more likely to develop in patients with bilateral renal artery stenosis greater than or equal to 50{\%} or severe atherosclerotic calcification of the aorta and iliac arteries.",
keywords = "Acute kidney injury, Atherosclerosis, CT angiogram, Renal artery stenosis, Transcatheter aortic valve replacement",
author = "Asha Kandathil and Suhny Abbara and Minna Hanna and Abu Minhajuddin and Lauren Wehrmann and Merchant, {Akeel M.} and Richard Mills and Fox, {Amanda A.}",
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T1 - Atherosclerosis on CT angiogram predicts acute kidney injury after transcatheter aortic valve replacement

AU - Kandathil, Asha

AU - Abbara, Suhny

AU - Hanna, Minna

AU - Minhajuddin, Abu

AU - Wehrmann, Lauren

AU - Merchant, Akeel M.

AU - Mills, Richard

AU - Fox, Amanda A.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - OBJECTIVE. The purpose of this study is to determine the association of vascular calcification and renal artery stenosis on CT angiogram (CTA) obtained before transcatheter aortic valve replacement (TAVR) with postprocedure acute kidney injury (AKI). MATERIALS AND METHODS. In this single-center retrospective cohort study, 106 pre-TAVR CTAs were evaluated by two independent blinded readers. Renal artery stenosis was visually graded as less than 50% or greater than or equal to 50% luminal narrowing. Calcification of the aorta and iliac arteries was scored from 0 (no calcification) to 3 (severe calcification) and was summed to develop a calcification score. Univariate comparisons between patients who did and did not develop AKI were made for radiologic measurements. Multivariable logistic regression was used to assess association of renal artery stenosis and atherosclerotic calcification with post-TAVR AKI. RESULTS. Post-TAVR AKI occurred in 20 of 106 patients. Subjects with bilateral main renal artery stenosis greater than or equal to 50% had significantly greater odds (odds ratio, 4.84; 95% CI, 1.41–16.54; p = 0.01) of developing post-TAVR AKI than did subjects with unilateral or no stenosis greater than or equal to 50% in the main renal arteries. Subjects who developed post-TAVR AKI had significantly higher aortic and iliac arterial calcification scores compared with subjects who did not develop post-TAVR AKI (mean ± SD, 21.4 ± 5.6 vs 17.9 ± 6.7; p = 0.04). CONCLUSION. AKI as a complication of TAVR is more likely to develop in patients with bilateral renal artery stenosis greater than or equal to 50% or severe atherosclerotic calcification of the aorta and iliac arteries.

AB - OBJECTIVE. The purpose of this study is to determine the association of vascular calcification and renal artery stenosis on CT angiogram (CTA) obtained before transcatheter aortic valve replacement (TAVR) with postprocedure acute kidney injury (AKI). MATERIALS AND METHODS. In this single-center retrospective cohort study, 106 pre-TAVR CTAs were evaluated by two independent blinded readers. Renal artery stenosis was visually graded as less than 50% or greater than or equal to 50% luminal narrowing. Calcification of the aorta and iliac arteries was scored from 0 (no calcification) to 3 (severe calcification) and was summed to develop a calcification score. Univariate comparisons between patients who did and did not develop AKI were made for radiologic measurements. Multivariable logistic regression was used to assess association of renal artery stenosis and atherosclerotic calcification with post-TAVR AKI. RESULTS. Post-TAVR AKI occurred in 20 of 106 patients. Subjects with bilateral main renal artery stenosis greater than or equal to 50% had significantly greater odds (odds ratio, 4.84; 95% CI, 1.41–16.54; p = 0.01) of developing post-TAVR AKI than did subjects with unilateral or no stenosis greater than or equal to 50% in the main renal arteries. Subjects who developed post-TAVR AKI had significantly higher aortic and iliac arterial calcification scores compared with subjects who did not develop post-TAVR AKI (mean ± SD, 21.4 ± 5.6 vs 17.9 ± 6.7; p = 0.04). CONCLUSION. AKI as a complication of TAVR is more likely to develop in patients with bilateral renal artery stenosis greater than or equal to 50% or severe atherosclerotic calcification of the aorta and iliac arteries.

KW - Acute kidney injury

KW - Atherosclerosis

KW - CT angiogram

KW - Renal artery stenosis

KW - Transcatheter aortic valve replacement

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