title: Incidence, predictive factors, and prognostic value of myocardial injury following uncomplicated transcatheter aortic valve implantation.
abstract: OBJECTIVE
  This study sought to: 1) determine the incidence, degree, and timing of the rise in serum cardiac markers of myocardial injury associated with uncomplicated transcatheter aortic valve implantation (TAVI); and 2) evaluate the predictive factors and prognostic value of myocardial injury associated with TAVI.
  
  
  BACKGROUND
  Very few data exist on the occurrence and clinical relevance of myocardial injury during TAVI procedures.
  
  
  METHODS
  A total of 101 patients who underwent successful TAVI (transfemoral [TF] approach, n = 38; transapical [TA] approach, n = 63) were included. Creatine kinase-MB (CK-MB) and cardiac troponin T (cTnT) levels were determined at baseline and at 6 to 12, 24, 48, and 72 h following TAVI.
  
  
  RESULTS
  TAVI was associated with some degree of myocardial injury in 99% of the patients (TF: 97%, TA: 100%) as determined by a rise in cTnT (maximal value, 0.48 μg/l, interquartile range [IQR]: 0.24 to 0.82 μg/l) and in 77% of the patients (TF: 47%, TA: 95%) as determined by a rise in CK-MB (maximal value, 18.6 μg/l; IQR: 11.0 to 27.4 μg/l). TA approach and baseline renal dysfunction were associated with a higher increase in biomarkers of myocardial injury (p < 0.01 for both). A larger myocardial injury was associated with a smaller improvement of left ventricular ejection fraction (LVEF) (p < 0.01). The degree of rise in cTnT was an independent predictor of cardiac mortality at 9 ± 10 months of follow-up (hazard ratio: 1.14 per each increase of 0.1 μg/l, 95% confidence interval: 1.02 to 1.28, p = 0.028).
  
  
  CONCLUSIONS
  TAVI was systematically associated with some degree of myocardial injury, with TA approach and baseline renal dysfunction determining a higher increase in biomarkers of myocardial injury. A greater degree of myocardial injury was associated with less improvement in LVEF and a higher cardiac mortality at follow-up.
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. josep.rodes@criucpq.ulaval.ca
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Marcos
authors.initials: M
authors.lastname: Gutiérrez
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.forename: Jacques
authors.initials: J
authors.lastname: Villeneuve
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Juan
authors.initials: J
authors.lastname: Manazzoni
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000378:metabolism / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D009206:Myocardium / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries
chemical_list: D015415:Biomarkers