title: Predictors and impact of myocardial injury after transcatheter aortic valve replacement: a multicenter registry.
abstract: BACKGROUND
  Cardiac biomarker release signifying myocardial injury post-transcatheter aortic valve replacement (TAVR) is common, yet its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown.
  
  
  OBJECTIVE
  This study sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation post TAVR.
  
  
  METHODS
  This multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical (TA) approaches were selected in 73.1% and 20.3% of patients, respectively. Creatine kinase-myocardial band (CK-MB) measurements were obtained at baseline and at several time points within the initial 72 h post TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up.
  
  
  RESULTS
  Overall, 66% of the TAVR population demonstrated some degree of myocardial injury as determined by a rise in CK-MB levels (peak value: 1.6-fold [interquartile range (IQR): 0.9 to 2.8-fold]). A TA approach and major procedural complications were independently associated with higher peak of CK-MB levels (p < 0.01 for all), which translated into impaired systolic left ventricular function at 6 to 12 months post TAVR (p < 0.01). A greater rise in CK-MB levels independently associated with an increased 30-day, late (median of 21 [IQR: 8 to 36] months) overall and cardiovascular mortality (p < 0.001 for all). Any increase in CK-MB levels was associated with poorer clinical outcomes, and there was a stepwise rise in late mortality according to the various degrees of CK-MB increase after TAVR (p < 0.001).
  
  
  CONCLUSIONS
  Some degree of myocardial injury was detected in two-thirds of patients post TAVR, especially in those undergoing TA-TAVR or presenting with major procedural complications. A greater rise in CK-MB levels associated with greater acute and late mortality, imparting a negative impact on left ventricular function.
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Henrique B
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Muñoz-García
authors.affiliation: Heart Institute-InCor, University of São Paulo, São Paulo, Brazil.
authors.forename: Pedro Alves
authors.initials: PA
authors.lastname: Lemos
authors.affiliation: Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Amat-Santos
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Vicenç
authors.initials: V
authors.lastname: Serra
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Fabio S
authors.initials: FS
authors.lastname: de Brito
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Rogério
authors.initials: R
authors.lastname: Sarmento-Leite
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: St. Michael's Hospital, Toronto University, Toronto, Ontario, Canada.
authors.forename: Asim N
authors.initials: AN
authors.lastname: Cheema
authors.affiliation: Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
authors.affiliation: University Heart Center, Transcatheter Valve Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: University Heart Center, Transcatheter Valve Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Cesar
authors.initials: C
authors.lastname: Moris
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Del Valle
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdul Jawad Altisent
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Del Trigo
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Francisco
authors.initials: F
authors.lastname: Campelo-Parada
authors.affiliation: Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Jimenez Quevedo
authors.affiliation: Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.
authors.forename: Juan H
authors.initials: JH
authors.lastname: Alonso-Briales
authors.affiliation: Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Hipólito
authors.initials: H
authors.lastname: Gutiérrez
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: García Del Blanco
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Perin
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: Dimytri
authors.initials: D
authors.lastname: Siqueira
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Bernardi
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Éric
authors.initials: É
authors.lastname: Dumont
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Côté
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D004452:Echocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D009656:North America / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013020:South America / Q000453:epidemiology; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: aortic stenosis; cardiac biomarkers; creatine kinase-MB; transapical; transcatheter aortic valve replacement