Author + information
- Martijn Stefan van Mourik,
- Floortje Van Kesteren,
- Esther M.A. Wiegerinck,
- R. Niels Planken,
- Jan Baan and
- Maartje Vis
Background: Computed tomography-angiography (CTA) is required in work-up for Transcatheter Aortic Valve Replacement (TAVR). In patients with impaired renal function CTA can cause contrast-induced nephropathy (CIN). The standard protocol for prevention of CIN in patients with heart failure is iv hydration with 24-h saline (NaCl). We hypothesized that hydration with 1-h sodium bicarbonate (NaHCO3) could be beneficial in reducing dyspnea caused by hydration while maintaining renal function.
Methods: Between Jan-2015 and Aug-2016, this open-label single-center randomized trial included 83 consecutive patients and was designed to show non-inferiority of 1-hour NaHCO3 (1.4%, 3 ml/kg/h) compared to 24-h hydration with NaCl (0.9%, 1 ml/kg/h). Patients were randomized on a 1:1 ratio; 39 saline, 43 sodium bicarbonate. Patients were stratified on eGFR: 45-60 (n=51), 30-45 (n=23), 15-30 (n=9). Primary outcome was relative change in serum creatinine (sCreat) 2-5 days after CTA. Secondary outcomes were the level of dyspnea (10-point BORG scale), CIN (increase in sCreat of >25%/or 44umol [0.5g/dL]) and use of dialysis. Netherlands Trial Register NTR5014.
Results: The relative increase in sCreat was 1.5% (95%CI 2.3-5.3%) versus 4.5% (95%CI 1.9-7.1%) for patients hydrating with saline and sodium bicarbonate respectively. On the predefined equivalence limit difference of 10% for the relative sCreat increase, non-inferiority testing was significant (99%CI −8.86-2.95, p<0.01). Mean increase in sCreat was 0.3 (95%CI −5.4-6.0) umol/L in saline vs 5.7 (95%CI 2.4-9.1) umol/L in sodium bicarbonate (p=0.091). Mean hydration volume was 1763 (SD 299) ml vs 234 (SD 43) ml in saline and sodium bicarbonate respectively (p<0.001). A BORG scale increase of at least 1 point was described more by patients hydrating with saline (20.6 vs 2.6% OR=9.852, RR=8.029, p=0.022). CIN and dialysis did not occur.
Conclusions: We demonstrate that for CTA in TAVR work-up, 1-h hydration with sodium bicarbonate is not inferior to standard 24-h saline hydration. This short protocol may replace standard hydration since this will shorten the length-of-stay, and may decrease the risk of decompensation.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: Expanding Clinical Applications
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1161-240
- 2017 American College of Cardiology Foundation