Table_1_Microcirculatory tissue oxygenation correlates with kidney function after transcatheter aortic valve implantation–Results from a prospective observational study.PDF

IntroductionKidney dysfunction is common in patients with aortic stenosis (AS) and correction of the aortic valve by transcatheter aortic valve implantation (TAVI) often affects kidney function. This may be due to microcirculatory changes.MethodsWe evaluated skin microcirculation with a hyperspectral imaging (HSI) system, and compared tissue oxygenation (StO2), near-infrared perfusion index (NIR), tissue hemoglobin index (THI) and tissue water index (TWI) in 40 patients undergoing TAVI versus 20 control patients. HSI parameters were measured before TAVI (t1), directly after TAVI (t2), and on postinterventional day 3 (t3). The primary outcome was the correlation of tissue oxygenation (StO2) to the creatinine level after TAVI.ResultsWe performed 116 HSI image recordings in patients undergoing TAVI for the treatment of severe aortic stenosis and 20 HSI image recordings in control patients. Patients with AS had a lower THI at the palm (p = 0.034) and a higher TWI at the fingertips (p = 0.003) in comparison to control patients. TAVI led to an increase of TWI, but had no uniform enduring effect on StO2 and THI. Tissue oxygenation StO2 at both measurement sites correlated negatively with creatinine levels after TAVI at t2 (palm: ρ = −0.415; p = 0.009; fingertip: ρ = −0.519; p < 0.001) and t3 (palm: ρ = −0.427; p = 0.008; fingertip: ρ = −0.398; p = 0.013). Patients with higher THI at t3 reported higher physical capacity and general health scores 120 days after TAVI.ConclusionHSI is a promising technique for periinterventional monitoring of tissue oxygenation and microcirculatory perfusion quality, which are related to kidney function, physical capacity, and clinical outcomes after TAVI.Clinical trial registrationhttps://drks.de/search/de/trial, identifier DRKS00024765.

主动脉瓣狭窄（AS）患者中肾脏功能障碍较为常见，而通过经导管主动脉瓣植入术（TAVI）对主动脉瓣的矫正往往会对肾脏功能产生影响。这种现象可能源于微循环的改变。研究方法：本研究采用高光谱成像（HSI）系统评估了患者的皮肤微循环，并比较了40例接受TAVI手术的患者与20例对照患者在组织氧饱和度（StO2）、近红外灌注指数（NIR）、组织血红蛋白指数（THI）和组织水分指数（TWI）等方面的差异。HSI参数在TAVI术前（t1）、术后即刻（t2）以及术后第3天（t3）进行测量。主要观察指标为TAVI术后血清肌酐水平与组织氧饱和度（StO2）的相关性。研究结果：我们对接受TAVI治疗严重主动脉瓣狭窄的116名患者进行了HSI图像记录，对20名对照患者进行了20次HSI图像记录。与对照患者相比，主动脉瓣狭窄患者的掌部THI较低（p = 0.034），指尖TWI较高（p = 0.003）。TAVI手术导致TWI增加，但对StO2和THI的影响并不一致且持久。在两个测量位点，组织氧饱和度StO2与TAVI术后t2（掌部：ρ = −0.415；p = 0.009；指尖：ρ = −0.519；p < 0.001）和t3（掌部：ρ = −0.427；p = 0.008；指尖：ρ = −0.398；p = 0.013）的血清肌酐水平呈负相关。在t3时THI较高的患者，在TAVI术后120天报告了更高的体能和总体健康评分。结论：高光谱成像技术在监测TAVI术后组织氧合和微循环灌注质量方面具有广阔的应用前景，这些指标与肾脏功能、体能以及临床预后密切相关。临床试验注册：https://drks.de/search/de/trial，标识符DRKS00024765。