title: The prognostic value of acute and chronic troponin elevation after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Myocardial injury occurs frequently following transcatheter aortic valve implantation (TAVI). The aim of this study was to assess timing, predictors, and prognostic value of periprocedural myocardial injury and chronic troponin elevation after TAVI.
  
  
  RESULTS
  Two hundred and seventy-six patients (logistic EuroSCORE 26.6±17.1%) underwent transvascular TAVI. Troponin, CK-MB, and NT-proBNP levels were measured before and after TAVI (1 hr, 4 hrs, 24 hrs, 48 hrs, 72 hrs, seven days, three, and six months). Myocardial injury (according to VARC-2 recommendation defined as ΔTroponin ≥15x URL) occurred in 143/276 patients (51.8%) during the first 72 hours following TAVI. Use of a self-expanding prosthesis (p=0.02), coronary artery disease (p=0.04), higher left ventricular ejection fraction (LVEF) (p<0.001), and procedure time (p<0.001) were independent predictors for the development of myocardial injury after TAVI. Thirty-day (4.2% vs. 6.1%; p=0.48) and one-year mortality (19.4% vs. 26.5%; p=0.15) were not related to the incidence of periprocedural myocardial injury. However, patients with chronic troponin elevation after TAVI had an increased one-year mortality risk (HR 4.5, 95% CI: 2.0-10.0; p<0.001).
  
  
  CONCLUSIONS
  Myocardial injury defined as ΔTroponin ≥15x URL after TAVI seems to be a procedure-related issue without impact on 30-day and one-year survival. However, monitoring of post-procedural troponin might be useful for prognostication after TAVI.
authors: Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors: Jan-Malte
authors: JM
authors: Sinning
authors: Christoph
authors: C
authors: Hammerstingl
authors: Robert
authors: R
authors: Schueler
authors: Annika
authors: A
authors: Neugebauer
authors: Sabine
authors: S
authors: Keul
authors: Alexander
authors: A
authors: Ghanem
authors: Fritz
authors: F
authors: Mellert
authors: Wolfgang
authors: W
authors: Schiller
authors: Cornelius
authors: C
authors: Müller
authors: Mariuca
authors: M
authors: Vasa-Nicotera
authors: Berndt
authors: B
authors: Zur
authors: Armin
authors: A
authors: Welz
authors: Eberhard
authors: E
authors: Grube
authors: Georg
authors: G
authors: Nickenig
authors: Nikos
authors: N
authors: Werner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin