Abstract 4363954: Renal Congestion After Transcatheter Aortic Valve Implantation Is Associated With Adverse Outcomes in Patients With Severe Aortic Stenosis

Background: Renal congestion is recognized as an important factor related to adverse outcomes in heart failure patients. Although transcatheter aortic valve implantation (TAVI) improves hemodynamic status in patients with severe aortic stenosis, the prognostic significance of renal congestion in the pre- and post-TAVI settings remains unclear. Therefore, we investigated its association with adverse outcomes following TAVI. Methods and Results: A total of 164 consecutive patients with severe aortic stenosis who underwent intrarenal Doppler ultrasonography both pre- and post-TAVI were enrolled. To assess renal congestion, intrarenal venous flow (IRVF) patterns were evaluated and categorized into two morphological types: a discontinuous pattern suggesting renal congestion and a continuous pattern indicating normal venous flow. Of the 164 patients, 38 patients (23.2%) exhibited a discontinuous IRVF pattern pre-TAVI, while 30 patients (18.3%) showed a discontinuous pattern post-TAVI. Patients were separately classified based on pre- and post-TAVI IRVF patterns, and the primary endpoint was defined as a composite of all-cause death or heart failure rehospitalization. During a median follow-up period of 698 days, a total of 37 patients (22.6%) experienced the composite outcome. Kaplan–Meier analysis showed no significant difference in the incidence of the composite outcome between the two groups classified by pre-TAVI IRVF patterns (log-rank P = 0.295, Figure A). In contrast, Kaplan–Meier analysis based on post-TAVI IRVF patterns demonstrated significantly worse outcomes in patients with a discontinuous pattern (log-rank P = 0.005, Figure B). In multivariable Cox regression analysis adjusted for age and sex, a discontinuous IRVF pattern post-TAVI remained independently associated with the composite outcome (HR 2.11, 95% CI 1.03–4.33, P = 0.042). Subgroup analyses stratified by clinical variables such as estimated glomerular filtration rate, B-type natriuretic peptide, and hemoglobin showed consistent results, indicating no significant interactions observed. Conclusions: Post-TAVI renal congestion, as indicated by a discontinuous IRVF pattern, was independently associated with adverse clinical outcomes following the procedure.