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置入术（TAVI）矫正主动脉瓣往往会对肾脏功能产生影响，此现象可能与微循环变化有关。研究方法方面，本研究采用高光谱成像（HSI）系统评估了40例接受TAVI手术患者的皮肤微循环，并与20例对照患者的组织氧合（StO2）、近红外灌注指数（NIR）、组织血红蛋白指数（THI）和组织水指数（TWI）进行了比较。HSI参数在TAVI术前（t1）、TAVI术后即刻（t2）以及术后第3天（t3）进行测量。主要研究结果是TAVI术后组织氧合（StO2）与肌酐水平的关联。研究结果方面，我们对116例接受TAVI治疗严重主动脉瓣狭窄的患者进行了HSI图像记录，并对20例对照患者进行了20次HSI图像记录。与对照患者相比，主动脉瓣狭窄患者在掌部（p = 0.034）的THI较低，而在指尖（p = 0.003）的TWI较高。TAVI导致TWI增加，但对StO2和THI的持久影响并不一致。在两个测量位点，组织氧合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天报告了更高的体力及总体健康评分。结论方面，高光谱成像（HSI）技术在围手术期监测组织氧合及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、体力以及TAVI术后临床结局密切相关。临床试验注册信息：https://drks.de/search/de/trial，识别码DRKS00024765。