title: Detection of myocardial injury by CMR after transcatheter aortic valve replacement.
abstract: BACKGROUND
  Myocardial injury after transcatheter aortic valve replacement (TAVR) is common, but its cause and relationship to the extent of myocardial tissue loss remain unclear.
  
  
  OBJECTIVE
  This study sought to examine the incidence and degree of ischemic myocardial damage using cardiac magnetic resonance imaging and myocardial biomarkers in patients undergoing TAVR.
  
  
  METHODS
  Patients with severe aortic stenosis (n = 61) underwent cardiac magnetic resonance imaging before and after TAVR for the assessment of new myocardial injury. High-sensitivity cardiac troponin T and creatine kinase-myocardial band were measured before and at 24, 48, and 72 h after TAVR.
  
  
  RESULTS
  After TAVR, new myocardial late enhancement (LE) with an ischemic pattern occurred in 11 patients (18%), with a mean mass of 3.7 g (interquartile range: 1.2 to 6 g) or 1.8% (interquartile range: 1.3% to 4.1%) of the left ventricular mass. Patients with new LE had a decreased left ventricular function (ejection fraction: pre, 55.5 ± 14.1% vs. post, 45.3 ± 14.9%; p = 0.001). In patients without new LE, no differences were observed (ejection fraction: pre, 53.9 ± 17.3% vs. post, 54.6 ± 16.3%; p = NS) after TAVR.
  
  
  CONCLUSIONS
  New ischemic-type myocardial LE after TAVR can be observed in a notable proportion of patients and is assumed to be of embolic origin. Patients with new LE feature a significant decrease in left ventricular function at discharge.
authors: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors: Won-Keun
authors: WK
authors: Kim
authors: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology, University of Giessen, Giessen, Germany.
authors: Andreas
authors: A
authors: Rolf
authors: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors: Christoph
authors: C
authors: Liebetrau
authors: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors: Arnaud
authors: A
authors: Van Linden
authors: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors: Johannes
authors: J
authors: Blumenstein
authors: Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors: Jörg
authors: J
authors: Kempfert
authors: Department of Radiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors: Georg
authors: G
authors: Bachmann
authors: Department of Cardiology, University of Giessen, Giessen, Germany.
authors: Holger
authors: H
authors: Nef
authors: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology, University of Giessen, Giessen, Germany.
authors: Christian
authors: C
authors: Hamm
authors: Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors: Thomas
authors: T
authors: Walther
authors: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany. Electronic address: h.moellmann@kerckhoff-klinik.de.
authors: Helge
authors: H
authors: Möllmann
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology; D009206:Myocardium / Q000473:pathology*; D011183:Postoperative Complications; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: TAVR; embolism; magnetic resonance imaging; myocardial infarction