Acute kidney injury after tavi is strongly associated with early heart failure decompensation a real-world cohort study

Background

Transcatheter aortic valve implantation (TAVI) is increasingly performed in elderly, comorbid patients. Acute kidney injury (AKI) is a frequent peri-procedural complication and may contribute to early heart failure (HF) decompensation through cardio-renal interactions. Evidence on the relationship between AKI and early HF events after TAVI in real-world cohorts remains limited.

Purpose

To evaluate the association between AKI after TAVI and early HF decompensation during the index hospitalization.

Methods

We conducted a retrospective, single-center analysis of consecutive patients undergoing TAVI. AKI after TAVI and early HF decompensation were assessed as in-hospital complications (binary outcomes). Categorical variables were compared using contingency tables and chi-square testing (with continuity correction as appropriate). Due to missing outcome data, analyses were performed in patients with available AKI and HF status.

Results

The overall cohort included 188 patients undergoing TAVI, with a mean age of 81 ± 7 years; 52% were female. The study population was characterized by a high burden of comorbidities, including a substantial prevalence of chronic kidney disease (CKD). Among patients with available renal function data, moderate-to-severe CKD (stage ≥3 or dialysis) was present in approximately one-third of the cohort.

Complete data on acute kidney injury (AKI) and early heart failure (HF) decompensation were available in 158 patients (84.0%). AKI occurred in 8 patients (5.1%), while early HF decompensation during index hospitalization was observed in 8 patients (5.1%).

Early HF decompensation was markedly more frequent among patients who developed AKI compared with those without AKI (37.5% vs 3.3%). This association was statistically significant (Pearson χ² = 18.44, df = 1, p < 0.001; continuity-corrected p < 0.001), identifying AKI as a strong determinant of early HF events after TAVI.

Conclusions

In this real-world TAVI cohort, AKI was strongly associated with early HF decompensation during the index hospitalization. These findings support close haemodynamic and renal monitoring after TAVI and highlight the potential value of peri-procedural strategies aimed at AKI prevention to reduce early HF complications.