Devil's staircase transition of the electronic structures in CeSb

Solids with competing interactions often undergo complex phase transitions with a variety of long-periodic modulations. Among such transition, devil's staircase is the most complex phenomenon, and for it, CeSb is the most famous material, where a number of the distinct phases with long-periodic magnetostructures sequentially appear below the Néel temperature. An evolution of the low-energy electronic structure going through the devil's staircase is of special interest, which has, however, been elusive so far despite 40 years of intense research. Here, we use bulk-sensitive angle-resolved photoemission spectroscopy and reveal the devil's staircase transition of the electronic structures. The magnetic reconstruction dramatically alters the band dispersions at each transition. Moreover, we find that the well-defined band picture largely collapses around the Fermi energy under the long-periodic modulation of the transitional phase, while it recovers at the transition into the lowest-temperature ground state. Our data provide the first direct evidence for a significant reorganization of the electronic structures and spectral functions occurring during the devil's staircase.

Transfer of orbital angular momentum of light to plasmonic excitations in metamaterials

The emergence of the vortex beam with orbital angular momentum (OAM) has provided intriguing possibilities to induce optical transitions beyond the framework of the electric dipole interaction. The uniqueness stems from the OAM transfer from light to material, as demonstrated in electronic transitions in atomic systems. In this study, we report on the OAM transfer to electrons in solid-state systems, which has been elusive to date. Using metamaterials (periodically textured metallic disks), we show that multipolar modes of the surface electromagnetic excitations (so-called spoof localized surface plasmons) are selectively induced by the terahertz vortex beam. Our results reveal selection rules governed by the conservation of the total angular momentum, which is confirmed by numerical simulations. The efficient transfer of light's OAM to elementary excitations in solid-state systems at room temperature opens up new possibilities of OAM manipulation.

Transition between Isotope-Mixing and Nonmixing States in Hydrogen-Deuterium Mixture Plasmas

The transition between isotope-mixing and nonmixing states in hydrogen-deuterium mixture plasmas is observed in the isotope (hydrogen and deuterium) mixture plasma in the Large Helical Device. In the nonmixing state, the isotope density ratio profile is nonuniform when the beam fueling isotope species differs from the recycling isotope species and the profile varies significantly depending on the ratio of the recycling isotope species, although the electron density profile shape is unchanged. The fast transition from nonmixing state to isotope-mixing state (nearly uniform profile of isotope ion density ratio) is observed associated with the change of electron density profile from peaked to hollow profile by the pellet injection near the plasma periphery. The transition from nonmixing to isotope-mixing state strongly correlates with the increase of turbulence measurements and the transition of turbulence state from TEM to ion temperature gradient is predicted by gyrokinetic simulation.

1677 Global longitudinal strain during dobutamine stress echocardiography can predict left ventricular remodeling after anterior wall acute myocardial infarction

Background

Although dobutamine stress echocardiography (DSE) at the early stage of acute myocardial infarction (AMI) is useful for the prediction of functional and clinical prognosis, the interpretation requires expertise. In this study, we sought to investigate if global longitudinal strain (GLS) during DSE after AMI can predict left ventricular remodeling (LVR).

Methods

Consecutive 30 patients with anterior wall AMI (18 male, age = 58 ± 13 years) were performed DSE 3 days after AMI. GLS was calculated as an averaged value of peak longitudinal strain in the apical 4- and 2-chamber views at baseline echocardiography, low-dose DSE (10 μg/kg/min) using available software (QLAB, Philips Medical Systems). Left ventricular remodeling (LVR) was defined as an echocardiographically determined increase in both EDVI and ESVI of 20% or more from baseline to the 6 month follow-up echocardiography.

Results

12 patients (40%) evolved with LVR. The change in GLS during low-dose DSE was significantly different between the remodeling and non-remodeling group (8 ± 5% v.s. 27 ± 20%, p < 0.05). Interestingly, it predicted LVR with sensitivity of 88%, specificity of 92% at the cut-off value of 12% (Area under the curve = 0.94, p < 0.0001).

Conclusion

The change in GLS during low-dose DSE can be used as a predictor for the LVR after AMI. This observation has promise for clinical applications.

Abstract 1677 Figure.

P10 A possible link between sarcopenia and major bleeding risk among patients with atrial fibrillation treated with oral anticoagulation undergoing coronary stenting

Background/Introduction

In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with stent implantation, oral anticoagulation (OAC) plus dual antiplatelet therapy (DAPT) increases the risk of bleeding. The PRECISE-DAPT (P-DAPT) and DAPT scores were created to predict increased bleeding versus ischemic risk in patients undergoing DAPT. However, not much information is available on predicting bleeding risk associated with OAC concomitant with DAPT in patients with AF treated with coronary stents. Physical frailty or sarcopenia is considered an emerging predictor for bleeding in AF patients.

Purpose

To investigate the relationship between skeletal muscle mass and major bleeding risk in AF patients undergoing PCI and subsequent OAC and DAPT.

Methods

A total of 1,234 consecutive patients after PCI using newer-generation drug eluting stents were evaluated. An anti-thrombotic regimen without OAC was given to 1,077 patients, whereas OAC was required in 157 patients (12.7%) including AF (n = 96). The P-DAPT, DAPT, and HAS-BLED scores were calculated for each of the patients. Any out-of-hospital major bleeding events were identified based on BARC criteria during a median follow-up of 2.9 years. The fat-free mass index (FFMI; kg/m2) was calculated to evaluate skeletal muscle mass as follows: (7.38 + 0.02908 × urinary creatinine (mg/day)) / (height squared (m2)). A Cox proportional hazards model was used to test the significance of the FFMI and these risk scores as predictors of major bleeding, defined as BARC 3 or 5 events in AF patients. The receiver operating characteristic curve (ROC) analyses were used to examine the predictive ability of the FFMI and these scores to identify patients with major bleeding events.

Results

Major bleeding events were observed in 9 (9.3%) patients. Major bleeding was associated with a lower FFMI (hazard ratio [HR] 0.53; 95% confidence interval [CI] 0.36-0.79; p = 0.002), and higher P-DAPT score (HR, 1.07; 95% CI, 1.02-1.11; p = 0.003), but not with the DAPT (HR, 0.71; 95% CI, 0.45-1.12; p = 0.147) and the HAS-BLED score (HR, 1.00; 95% CI, 0.48-2.09; p = 0.990). In the non-OAC cohort, major bleeding was related to a higher P-DAPT score (HR, 1.05; 95% CI, 1.02-1.07; p < 0.0001), but the FFMI (HR, 0.89; 95% CI, 0.73-1.09; p = 0.265) and the DAPT score were not correlated. C-statistics for major bleeding events were 0.82 (95% CI, 0.71-0.93, p = 0.001) for the FFMI and 0.79 (95% CI, 0.68-0.90, p = 0.004) for the P-DAPT score.

Conclusions

Assessment of the FFMI for screening sarcopenia is useful to predict major bleedings specifically in patients with AF undergoing coronary stenting. Both the FFMI and P-DAPT could successfully predict major bleedings in AF patients after PCI. Whether novel bleeding risk scores combined with measuring body composition adequately identify high risk patients needs to be validated.

Modulation of methotrexate-induced intestinal mucosal injury by dietary factors

Methotrexate (MTX)-induced intestinal mucosal injury in animals has been studied to understand how MTX can cause gastrointestinal disorders, but the pathogenesis of gastrointestinal disorders is still uncertain. We have attempted to reveal how dietary factors influence intestinal toxicity due to MTX. Mice were fed normal chow (NC) or a high-fat high-sucrose diet (HFHSD) before oral administration of MTX. While MTX significantly decreased the survival rates of mice fed HFHSD, the intestinal epithelial injury was detected. MTX excretion in the feces of mice fed HFHSD was reduced. Change of diets between NC and HFHSD influences the survival. The survival rates of the mice fed a high-sucrose diet or control diet were higher than those fed HFHSD. Higher survival rates were observed in mice fed a high-fat high-sucrose diet modified (HFHSD-M) in which casein was replaced by soybean-derived proteins. The survival rates of mice treated with vancomycin were lower than those administered neomycin. Microbiome and metabolome analyses on feces suggest a similarity of the intestinal environments of mice fed NC and HFHSD-M. HFHSD may modify MTX-induced toxicity in intestinal epithelia on account of an altered MTX distribution as a result of change in the intestinal environment.

DWI for Monitoring the Acute Response of Malignant Gliomas to Photodynamic Therapy

BACKGROUND AND PURPOSE

Photodynamic therapy is a novel treatment that provides effective local control, but little is known about photodynamic therapy-induced changes on MR imaging. The aim of this study was to assess the utility of DWI and ADC in monitoring the response of malignant gliomas to photodynamic therapy.

MATERIALS AND METHODS

Time-dependent changes in DWI and ADC values after photodynamic therapy were analyzed in a group that received photodynamic therapy in comparison with a group that did not.

RESULTS

Twenty-four patients were enrolled (photodynamic therapy, n = 14; non-photodynamic therapy, n = 10). In all patients who received photodynamic therapy, linear high signals on DWI in the irradiated area were detected adjacent to the resection cavity and were 5-7 mm in depth from 1 day posttreatment and disappeared in about 30 days without any neurologic deterioration. The non-photodynamic therapy group did not show this change. The photodynamic therapy group had significantly lower ADC values from 1 day posttreatment (P < .001), which increased steadily and disappeared by 30 days. There was no decline or time-dependent change in ADC values in the non-photodynamic therapy group.

CONCLUSIONS

The acute response of malignant gliomas to photodynamic therapy was detected as linear high signals on DWI and as a decrease in ADC values. These findings were asymptomatic and transient. Although the photodynamic therapy-induced acute response on MR imaging disappeared after approximately 30 days, it may be helpful for confirming the photodynamic therapy-irradiated area.

Isotope Effect on Energy Confinement Time and Thermal Transport in Neutral-Beam-Heated Stellarator-Heliotron Plasmas

The isotope effect on energy confinement time and thermal transport has been investigated for plasmas confined by a stellarator-heliotron magnetic field. This is the first detailed assessment of an isotope effect in a stellarator heliotron. Hydrogen and deuterium plasmas heated by neutral beam injection on the Large Helical Device have exhibited no significant dependence on the isotope mass in thermal energy confinement time, which is not consistent with the simple gyro-Bohm model. A comparison of thermal diffusivity for dimensionally similar hydrogen and deuterium plasmas in terms of the gyroradius, collisionality, and thermal pressure has clearly shown robust confinement improvement in deuterium to compensate for the unfavorable mass dependence predicted by the gyro-Bohm model.

P2721FFRct analysis for screening of obstructive coronary artery disease: a propensity score adjusted study

Background

Guidelines recommend functional assessment in stable coronary artery disease (CAD) to guide further treatment. Computed tomography fractional flow reserve (FFRCT) has been proposed for non-invasive assessment of stable CAD. A cutoff value of FFRCT ≥0.8 has been shown cost-effective, and allowing to avoid inappropriate invasive coronary angiography (ICA). However, no results from real-life hospital registries have been reported yet.

Purpose

We aimed to compare the impact of FFRCT with conventional coronary CT angiography (CTA) for detecting obstructive CAD in the daily practice of a tertiary referral hospital.

Methods

Patients referred to CTA for suspected CAD between 2013 and 2017 were included. FFRCT analysis was introduced in 2015 and performed at the discretion of the radiologist by Heartflow Inc. FFRCT was considered abnormal if FFR was <0.8 in at least one of 3 main vessels. Obstructive CAD was defined on both CTA and ICA by the presence of a stenosis ≥50% in at least one of 3 main vessels, or an invasive FFR<0.8. Propension to perform a FFRCT was modeled, based on gender, cardiovascular risk factors, completion of stress test and echocardiography and presence of a lesion of more than 50% stenosis on CTA. A logistic regression adjusted for the propensity score was then performed on the use of ICA, the presence of significant CAD on ICA and revascularization rate either by PCI or CABG.

Results

2906 patients (50% of male, 56±12) were included in this registry. Diabetes, hypertension, dyslipidemia and smoking were present in respectively 12.3, 30.5, 27.5 and 9% of patients. A stress ECG and a transthoracic echo were obtained in respectively 37.1 and 49% of patients. FFRCT was performed in 757 (26%) and was abnormal in 323 (42.7%) of the patients. An ICA was performed in 622 (21.4%) patients and was abnormal in 292 (46.9%). After propensity score weighting, FFRCT was associated with an increase in ICA (OR=1.58, 95% CI: 1.23–2.02, p<0.01). There were no significant changes regarding ICA showing obstructive CAD with FFRCT (OR=1.13, 95% CI: 0.78–1.66, p=0.5) but a trend towards an increase of revascularization (OR=1.48, 95% CI: 0.98–2.24, p=0.06). In patient undergoing an ICA, a FFRCT ≥0.8 was decreasing the presence of significant CAD (OR=0.27, 95% CI: 0.16–0.48, p<0.001), whereas a FFRCT <0.8 increased the rate of revascularization (OR=24.7, 95% CI: 12.3–49.7, p<0.001).

Conclusion

These real life data showed that, adding FFRCT to conventional CTA, and interpreting only the numerical values of FFRCT, would increase the use of ICA in patients suspected of CAD. A trend towards an increase in revascularization was also observed. Therefore, another index than the minimal FFRCT should be used to improve discrimination regarding the presence of obstructive CAD. However, normal values of FFRCT were strong predictors of the absence of significant CAD, and abnormal values of FFRCT for the need of a revascularization.

P4661Increased levels of sST2 in patients with mitral annulus disjunction and ventricular arrhythmias

Background

Mitral annulus disjunction (MAD), a basal displacement of the mitral valve annulus, is described as a possible aetiology of sudden cardiac death. Stretch-induced fibrosis in the sub-valvular apparatus has been suggested as the substrate of arrhythmias.

Purpose

We hypothesized that the stretch related biomarker soluble Suppression of Tumorigenicity-2 (sST2) is a marker of ventricular arrhythmias in patients with MAD.

Methods

We included patients with ≥1 mm MAD on cardiac magnetic resonance imaging, and recorded left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) suggesting papillary muscle fibrosis. Circulating levels of sST2 were assessed by blood sampling. The occurrence of ventricular arrhythmias, defined as aborted cardiac arrest, sustained or non-sustained ventricular tachycardia, was assessed retrospectively.

Results

We included 72 patients with MAD [55 (35–62) years old, 48 (67%) female], of which 22 (31%) had ventricular arrhythmias. Patients with ventricular arrhythmias had lower LVEF (60±6% vs. 63±6%, p=0.04), more prevalent papillary muscle fibrosis [14 (64%) vs. 10 (20%), p<0.001] and higher sST2 levels [31.6±10.1 ng/mL vs. 25.3±9.2 ng/mL, p=0.01] compared to those without. Combining sST2-level, LVEF and papillary muscle fibrosis optimally detected individuals with arrhythmias (area under the curve 0.82, 95% CI 0.73–0.92) and improved the risk model (p<0.05) compared to individual parameters (Figure right panel).

Conclusion

Circulating sST2 levels were higher in patients with MAD and ventricular arrhythmias compared to patients without arrhythmias. Combining sST2, LVEF and LGE may improve risk stratification in patients with MAD.

Acknowledgement/Funding

This work was supported by public grant [203489/030] from the Norwegian Research Council, Oslo, Norway. E. Scheirlynck received an ESC research grant

P5652Catheter ablation outcome and heart failure hospitalization in atrial fibrillation patients with preserved left ventricular ejection fraction: insights from the Kansai plus atrial fibrillation (KPAF)

Background

Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF), and AF is an independent prognostic factor in HF patients with preserved left ventricular ejection fraction (LVEF). Radiofrequency catheter ablation (RFCA) for AF is effective to maintain sinus rhythm.

Purpose

We sought to clarify incidence of HF hospitalization and whether AF ablation outcome influenced incidence of HF hospitalization after the procedures in patients with preserved LVEF.

Methods

We conducted a large-scale, prospective, multicenter, observational study. A total of 4522 consecutive patients with normal LVEF (>/- 50%) who underwent an initial RFCA for AF in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 33.7%). The median follow-up duration was 2.9 years.

Results

The 3-year cumulative incidence of AF recurrence after a single procedure was 40.3%. Hospitalization for HF was observed in 60 patients (1.3%) and was significantly higher in patients with AF recurrence than those without it (2.63% vs 0.44%, log-rank p<0.001). After adjustment by age ≥65 years, estimated glomerular filtration rate ≤60ml/min, history of HF, and female, all of which were statistically associated with a risk of HF hospitalization, AF recurrence after the index RFCA was an independent predictor of HF hospitalization (hazard ratio; 4.75, 95% confidence interval; 2.59–9.42, p<0.001).

Conclusions

Recurrence after RFCA for AF was a significant risk of HF hospitalization among AF patients with preserved LVEF.

Acknowledgement/Funding

This study was supported by the Research Institute for Production Development in Kyoto, Japan.

P3587Tip detection method using the new short-tip IVUS with pull-back system which facilitates the 3D wiring technique in percutaneous coronary intervention for chronic total occlusion

Background

The strategy of intravascular ultrasound (IVUS)-guided wiring for CTO PCI, that is, leading the second guidewire into the true lumen under observing by IVUS from subintimal space, is the last resort. We developed the angiography-based 3D wiring method. During establishment of the angiography-based 3D wiring method, we deduced that observation of the guidewire tip as well as the shaft named “The tip detection method” simplifies and facilitates 3D wiring under IVUS-guided wiring. Therefore, we produced New CTO IVUS which is the upgraded version of Navifocus WR IVUS by adding the pull-back transducer system. This pull-back system enables us to detect the tip as well as the shaft of the second guidewire in real time (tip detection method), which facilitates the 3D wiring technique under IVUS-guided wiring.

Objective

We evaluated the efficacy of the tip detection method during 3D wiring for CTO PCI with New CTO IVUS.

Method

We created a target pinpoint penetration model and performed the procedures using an experimental heartbeat model. The target (a tube with a lumen 0.6 mm in diameter) was placed in the distal part of a CTO 20 mm in length made of 2.5% agar. After the second guidewire (Conquest-12g) was advanced into the CTO lesion to within 5mm of the target using the angiography-based wiring, IVUS-guided wiring was performed by using Navifocus WR or New CTO IVUS each five times.

Result

The frequency of the puncture time was reduced using the new CTO IVUS compared to the Navifocus WR (1.7±0.8 vs. 28.8±23.2, p=0.17). The procedure time was significantly shorter using the new CTO IVUS compared to the Navifocus WR (103±61 vs. 459±373 seconds, p=0.04).

Conclusion

The tip detection method during 3D wiring with the new short tip IVUS with the pull-back system enables us to easily perform 3D wiring and will change the CTO PCI strategy.

P971Impact of treatment strategy on 1-year outcome for Left Main trifurcation lesions

Background/Introduction

Limited data exist regarding procedural strategy and clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main (LM) trifurcation lesion.

Purpose

The aim of this study is to evaluate 1-year clinical outcomes after LM trifurcation PCI comparing different strategies in kissing balloon inflation (KBI).

Methods

From 1, January, 2011 to 31, March, 2017, patients who underwent LM trifurcation PCI with second generation drug-eluting stent in our center were retrospectively analyzed. They were categorized into single-stent KBT group (KBT in left anterior descending artery [LAD] and left circumflex artery [LCX], or LAD and high lateral branch [HL]) and no-KBT group. Primary endpoint is restenosis in the lesions.

Results

Among 1301 patients who underwent LM PCI during the study period, 163 patients (12.5%) had a trifurcation lesion. Regarding the number of stents used for the lesions, 1, 2 and 3 stents were used in 75.4%, 22.0% and 2.5%, respectively. Median follow-up period of LM trifurcation patients was 265 days (interquartile range: 81–564). In the no-KBT group (64 patients), 19 patients experienced restenosis of HL and LCX (HL: 8 patients, LCX: 0 patient, and both: 11 patients). In the KBT-group, KBT for LAD and LCX was performed in 47 patients, and of them, 19 patients experienced restenosis of LM-LAD, HL and LCX (HL: 12 patients, LCX: 6 patients and all: 1 patient). On the other hand, in 9 patients with KBT for LAD and HL, there were no restenosis cases at 1-year follow-up. There was no statistically significant difference in restenosis rate between the no-KBI and KBT group (29.6% vs. 40.4%, p=0.69).

Restenosis rates in each segments

Conclusion

After LM trifurcation PCI, restenosis rate at 1-year follow-up was high, and no difference between no-KBT and KBT group overall. However, there was no restenosis case in patients with KBT for LAD and HL.

P1029Catheter ablation outcome and heart failure hospitalization in atrial fibrillation patients: insights from the Kansai plus atrial fibrillation (KPAF) registry

Background

Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) for AF is effective to maintain sinus rhythm.

Purpose

We sought to clarify whether AF ablation outcome influenced incidence of HF hospitalization after the procedures.

Methods

We conducted a large-scale, prospective, multicenter, observational study. A total of 5010 consecutive patients who underwent an initial RFCA for AF in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 35.6%). The median follow-up duration was 2.9 years.

Results

The 3-year cumulative incidence of AF recurrence after a single procedure was 40.2%. The 3-year incidence of hospitalization for HF was observed in 92 patients (1.8%) and was significantly higher in patients with AF recurrence than those without it (3.3% vs 0.84%, log-rank p<0.001). After adjustment by advanced age,(≥65 years), reduced left ventricular ejection fraction (≤50%), low estimated glomerular filtration rate (≤60ml/min), and history of HF, all of which were statistically associated with a risk of HF hospitalization (p<0.1, respectively), AF recurrence after the index RFCA was an independent predictor of HF hospitalization (hazard ratio [HR]; 3.17, 95% confidence interval [CI]; 2.06–5.04, p<0.001).Even after multiple procedures (1425 re-ablation sessions in 1274 patients [25.4%]), AF recurrence after the last procedure was an independent predictor of HF hospitalization (HR; 2.83, 95% CI; 1.89–4.24, p<0.001).

Conclusions

Among AF patients receiving RFCA, those with AF recurrence were at greater risk of heart failure hospitalization than were patients without AF recurrence. These differences should be noted when treating AF patients in actual clinical practice.

Acknowledgement/Funding

This study was supported by the Research Institute for Production Development in Kyoto, Japan.

P6530Clinical outcomes of dialysis patients treated with current generation DES for left main distal bifurcation

Objectives

We assessed clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main (ULM) using current generation drug eluting stents (cDES) in hemodialysis (HD) patients compared to general populations.

Methods

We identified 1269 consecutive patients who underwent PCI for ULM distal bifurcation lesions. Of them, 563 patients were treated with cDES (512 non HD and 51 HD patients). The primary endpoint was target lesion failure (TLF) at 3 years, defined as a composite of cardiac death, target lesion revascularization (TLR) and myocardial infarction (MI).

Results

HD group was more likely to have diabetes mellitus (70.0% vs. 45.8%, p=0.002), peripheral artery disease (56.0% vs. 14.9%, p<0.001), and lower ejection fraction (52.6% vs. 56.3%, p=0.026). The rate of TLF at 3 years was significantly higher in the HD group (adjusted Hazard ratio [HR] 2.59; 95% confidence interval [CI], 1.54–4.37; p<0.001). Cardiac mortality was significantly higher in the HD group (adjusted HR 4.49; 95% CI, 2.07–9.74; p<0.001). The rates of TLR for LM-left anterior descending artery (LAD) and left circumflex ostium (LCXos) were significantly higher in the HD group (LMT-LAD: adjusted HR 3.10; 95% CI, 1.31–7.33; p=0.01, LCXos: adjusted HR 2.56; 95% CI, 1.32–4.94; p=0.005). The rate of MI was similar between the 2 groups.

Conclusions

Hemodialysis was strongly associated with adverse events after PCI for ULM distal bifurcation lesions even with cDES.

P5577Preoperative transaortic pressure gradient predicts renal functional improvement after transcatheter aortic valve implantation in patients with chronic kidney disease

Introduction

Transcatheter aortic valve implantation (TAVI) theoretically increases renal blood flow through increasing cardiac output by relieving aortic valvular obstruction of blood flow from left ventricle, resulting in a renal functional recovery in patients with severe aortic valve stenosis (AS). However, procedural steps of TAVI including contrast use potentially damages renal medulla and may deteriorate renal function.

Purpose

The aim of this study was to investigate renal functional change and clarify preoperative predictors for renal functional improvement after TAVI in chronic kidney disease (CKD) patients with severe AS.

Methods

A total of 88 consecutive severe AS patients with CKD (grade >3) who underwent TAVI from 2015 to 2018 was enrolled in this observational study. They were divided into two groups depending on their renal functional improvement after TAVI that was defined as more than 10% increase in estimated glomerular filtration rate (eGFR) at discharge from their preoperative level.

Results

Among the whole candidates, 49 patients (55.7%) were improved their renal function. Patients with the lowest preoperative eGFR achieved the highest increase in eGFR after TAVI (CKD grade >4: +22.7±23.7%, Figure). Patients in the Improved group had lower hemoglobin level, higher mean transaortic pressure gradient (TAPG), and higher aortic valve gradient before TAVI, compared to those in the Non-improved group. However, contrast volume during the procedure was not significantly different between the groups. Multivariate logistic regression analysis revealed that high mean TAPG and low left ventricular ejection fraction (LVEF) before TAVI were independent predictors for the improvement of renal function (odds ratio (OR): 1.04, 95% confidence interval (CI): 1.00–1.08; OR: 0.94, 95% CI: 0.89–0.99, respectively), even after the adjustment of baseline eGFR level and hemoglobin level that were statistically significant on univariate logistic regression analysis. Receiver Operating Characteristic (ROC) curve showed the cut-off level of preoperative mean TAPG in renal functional improvement after TAVI as 47.0 mmHg (Sensitivity: 47.9%, Specificity: 79.5%, area under the curve: 0.62).

Correlation between CKDgrade and ΔeGFR

Conclusions

Preoperative high mean TAPG may predict renal functional improvement after TAVI in patients with deteriorated renal function. This non-invasive predictor may help clinicians to consider to perform TAVI in a challenging case with severe CKD.