title: Myocardial injury during transfemoral transcatheter aortic valve implantation: an intracoronary Doppler and cardiac magnetic resonance imaging study.
abstract: OBJECTIVE
  Myocardial injury reflected by a post-procedural increase of serum troponin I (TnI) occurs frequently during transcatheter aortic valve implantation (TAVI). It is potentially caused by intraprocedural hypotension, periprocedural coronary microembolisation and post-procedural (para)valvular leakages (PVLs). We invasively assessed coronary flow dynamics including coronary flow velocity reserve (CFVR), embolic high-intensity transient signals (HITS) as well as rapid pacing induced hypotension and post-procedural PVLs to determine their contribution to post-procedural TnI increases.
  
  
  RESULTS
  In 15 transfemoral TAVI patients, TnI was measured serially, and cardiac MRIs with late gadolinium enhancement (LGE) were performed pre- and post-interventionally. There were no significant correlations between coronary flow dynamics, CFVR and the area under the curve (AUC) of TnI over 72 hours. Despite the detection of HITS in all patients and during all procedural steps, there was also no correlation between the amount of HITS and the AUC of TnI. However, there were positive correlations between the duration of rapid pacing as well as the time of subsequent blood pressure recovery and the AUC of TnI. Both LGE and more than mild PVL were observed in a single case only.
  
  
  CONCLUSIONS
  Myocardial injury after TAVI appears to be related more to hypoperfusion-induced ischaemia than to periprocedural microembolisation.
authors.affiliation: Department of Cardiology, West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.forename: Fadi
authors.initials: F
authors.lastname: Al-Rashid
authors.forename: Björn
authors.initials: B
authors.lastname: Plicht
authors.forename: Carolin
authors.initials: C
authors.lastname: Wild
authors.forename: Dirk
authors.initials: D
authors.lastname: Westhölter
authors.forename: Heike
authors.initials: H
authors.lastname: Hildebrandt
authors.forename: Theodor
authors.initials: T
authors.lastname: Baars
authors.forename: Till
authors.initials: T
authors.lastname: Neumann
authors.forename: Felix
authors.initials: F
authors.lastname: Nensa
authors.forename: Kai
authors.initials: K
authors.lastname: Nassenstein
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.forename: Eva
authors.initials: E
authors.lastname: Kottenberg
authors.forename: Jürgen
authors.initials: J
authors.lastname: Peters
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002304:Cardiac Pacing, Artificial; D003326:Coronary Circulation; D015150:Echocardiography, Doppler; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007022:Hypotension / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I