title: Prevalence and effect of myocardial injury after transcatheter aortic valve replacement.
abstract: The incidence and prognostic implication of myocardial injury after transcatheter aortic valve replacement (TAVR) have not been consistently studied. We aimed to assess the incidence and extent of myocardial injury after TAVR performed using transfemoral and transapical approaches. The clinical data from patients with aortic stenosis who underwent TAVR were retrospectively analyzed. The myocardial necrosis markers cardiac troponin I and creatine kinase (CK)-MB were assessed during hospitalization. Of the 150 TAVR patients, 95% and 50% had an abnormally elevated cardiac troponin I and CK-MB level, respectively. The transapical patients had significantly greater elevations of both cardiac troponin I (13.8 ± 14.0 vs 2.5 ± 5.8 ng/ml, p <0.001) and CK-MB (28.4 ± 24.2 vs 7.4 ± 8.6 ng/ml, p ≤0.001). On receiver operating curve analysis, postprocedural CK-MB (twofold increase) had high predictive power for 30-day mortality (area under the curve 0.85, p <0.001). Patients with high CK-MB levels had greater rates of postprocedural kidney injury (22% vs 6%, p = 0.026), in-hospital (22% vs 0%, p <0.001), 30-day (27% vs 1.5%, p <0.001), and 1-year mortality (41% vs 18%, p = 0.01). Baseline renal failure and no β-blocker treatment on admission were independent predictors of an elevated postprocedural CK-MB level. In conclusion, a cardiac biomarker increase after TAVR was common and more frequent among transapical access patients. A twofold increase (>7 ng/ml) in CK-MB after transfemoral TAVR was a surrogate for poor long-term outcomes.
authors: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors: Israel M
authors: IM
authors: Barbash
authors: Danny
authors: D
authors: Dvir
authors: Itsik
authors: I
authors: Ben-Dor
authors: Salem
authors: S
authors: Badr
authors: Petros
authors: P
authors: Okubagzi
authors: Rebecca
authors: R
authors: Torguson
authors: Paul J
authors: PJ
authors: Corso
authors: Zhenyi
authors: Z
authors: Xue
authors: Lowell F
authors: LF
authors: Satler
authors: Augusto D
authors: AD
authors: Pichard
authors: Ron
authors: R
authors: Waksman
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006350:Heart Valve Prosthesis; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D009206:Myocardium / Q000378:metabolism; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form