1 © Europa Digital & Publishing 2013. All rights reserved. CLINICAL RESEARCH EuroIntervention 2013; 9-online publish-ahead-of-print October 2013 *Corresponding author: Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. E-mail: nikos.werner@ukb.uni-bonn.de Doppler-based renal resistance index for the detection of acute kidney injury and the non-invasive evaluation of paravalvular aortic regurgitation after transcatheter aortic valve implantation Jan-Malte Sinning, MD; Viktoria Adenauer, MD; Anne-Cathérine Scheer, MD; Sisa Josefina Lema Cachiguango, MD; Alexander Ghanem, MD; Christoph Hammerstingl, MD; Alexander Sedaghat, MD; Cornelius Müller, MD; Mariuca Vasa-Nicotera, MD; Eberhard Grube, MD; Georg Nickenig, MD; Nikos Werner*, MD Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany J.M. Sinning and V. Adenauer contributed equally to this paper. The accompanying supplementary data are published online at: http://www.pcronline.com/eurointervention/ahead_of_print/201310-05 Abstract Aims: Acute kidney injury (AKI) is a strong but rather late predictor of mortality after transcatheter aortic valve implantation (TAVI). Early clinically useful markers for the detection of AKI and prediction of outcome are needed in order to control and improve management of periprocedural complications after TAVI. The aim of our study was to assess the predictive value of the Doppler-based renal resistance index (RRI), which cor- relates inversely with effective renal blood flow and creatinine clearance, for AKI in patients undergoing TAVI and to evaluate its association with paravalvular aortic regurgitation (PAR). Methods and results: TAVI was performed with the Medtronic CoreValve prosthesis in 132 consecutive high-risk patients (mean logistic EuroSCORE: 30.3±18.2%). RRI, serum creatinine and cystatin C level were determined before, and 4 hrs, 24 hrs, 48 hrs, 72 hrs, and 7 days after TAVI. AKI occurred in 32/132 patients (24.2%). While serum creatinine and cystatin C levels decreased at first after TAVI (also in most patients developing AKI), the RRI increased significantly immediately after the procedure from 0.79±0.09 to 0.87±0.12 in patients developing AKI (p=0.003). A RRI >0.85 predicted post-interventional AKI with a sen- sitivity of 58% and specificity of 86%, and was superior to the serum creatinine level (p<0.001). In addition, an elevated RRI was significantly related to haemodynamic changes after TAVI and was associated with the occurrence of moderate/severe PAR (p<0.001). Conclusions: Measurement of the Doppler-based RRI predicts risk for AKI and increased mortality rates at an early post-procedural time point and is related to the occurrence of more-than-mild paravalvular aortic regurgitation after TAVI. KEYWORDS • acute kidney injury • CoreValve • paravalvular aortic regurgitation • resistance index • TAVI • TAVR