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Hecht S, Giuliani C, Nuche J, Farjat Pasos JI, Bernard J, Tastet L, Abu-Alhayja'a R, Beaudoin J, Côté N, DeLarochellière R, Paradis JM, Clavel MA, Arsenault BJ, Rodés-Cabau J, Pibarot P. Multimarker Approach to Improve Risk Stratification of Patients Undergoing Transcatheter Aortic Valve Implantation. JACC. ADVANCES 2024; 3:100761. [PMID: 38939373 PMCID: PMC11198363 DOI: 10.1016/j.jacadv.2023.100761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 06/29/2024]
Abstract
Background A blood multimarker approach may be useful to enhance risk stratification in patients undergoing TAVI. Objectives The objective of this study was to determine the prognostic value of multiple blood biomarkers in transcatheter aortic valve implantation (TAVI) patients. Methods In this prospective study, several blood biomarkers of cardiovascular function, inflammation, and renal function were measured in 362 patients who underwent TAVI. The cohort was divided into 3 groups according to the number of elevated blood biomarkers (ie, ≥ median value for the whole cohort) for each patient before the procedure. Survival analyses were conducted to evaluate the association between blood biomarkers and risk of adverse event following TAVI. Results During a median follow-up of 2.5 (IQR: 1.9-3.2) years, 34 (9.4%) patients were rehospitalized for heart failure, 99 (27%) patients died, and 113 (31.2%) met the composite endpoint of all-cause mortality or heart failure rehospitalization. Compared to patients with 0 to 3 elevated biomarkers (referent group), those with 4 to 7 and 8 to 9 elevated biomarkers had a higher risk of all-cause mortality (HR: 1.54 [95% CI: 0.84-2.80], P = 0.16, and HR: 2.81 [95% CI: 1.53-5.15], P < 0.001, respectively) and of the composite endpoint (HR: 1.65 [95% CI: 0.95-2.84], P = 0.07, and HR: 2.67 [95% CI: 1.52-4.70] P < 0.001, respectively). Moreover, adding the number of elevated blood biomarkers into the clinical multivariable model provided significant incremental predictive value for all-cause mortality (Net Reclassification Index = 0.71, P < 0.001). Conclusions An increasing number of elevated blood biomarkers is associated with higher risks of adverse clinical outcomes following TAVI. The blood multimarker approach may be helpful to enhance risk stratification in TAVI patients.
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Affiliation(s)
- Sébastien Hecht
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Carlos Giuliani
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Jorge Nuche
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Julio I. Farjat Pasos
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Jérémy Bernard
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Lionel Tastet
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Rami Abu-Alhayja'a
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Nancy Côté
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Robert DeLarochellière
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Marie-Annick Clavel
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Benoit J. Arsenault
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Philippe Pibarot
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
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de Sá Marchi MF, Calomeni P, Gauza MDM, Kanhouche G, Ravani LV, Rodrigues CVF, Tarasoutchi F, de Brito FS, Rodés-Cabau J, Van Mieghem NM, Abizaid A, Ribeiro HB. Impact of periprocedural myocardial injury after transcatheter aortic valve implantation on long-term mortality: a meta-analysis of Kaplan-Meier derived individual patient data. Front Cardiovasc Med 2023; 10:1228305. [PMID: 38028447 PMCID: PMC10667910 DOI: 10.3389/fcvm.2023.1228305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Periprocedural myocardial injury (PPMI) frequently occurs after transcatheter aortic valve implantation (TAVI), although its impact on long-term mortality is uncertain. Methods We performed a pooled analysis of Kaplan-Meier-derived individual patient data to compare survival in patients with and without PPMI after TAVI. Flexible parametric models with B-splines and landmark analyses were used to determine PPMI prognostic value. Subgroup analyses for VARC-2, troponin, and creatine kinase-MB (CK-MB)-defined PPMI were also performed. Results Eighteen observational studies comprising 10,094 subjects were included. PPMI was associated with lower overall survival (OS) after two years (HR = 1.46, 95% CI 1.30-1.65, p < 0.01). This was also observed when restricting the analysis to overall VARC-2-defined PPMI (HR = 1.23, 95% CI 1.07-1.40, p < 0.01). For VARC-2 PPMI criteria and VARC-2 troponin-only, higher mortality was restricted to the first 2 months after TAVI (HR = 1.64, 95% CI 1.31-2.07, p < 0.01; and HR = 1.32, 95% CI 1.05-1.67, p = 0.02, respectively), while for VARC-2 defined CK-MB-only the increase in mortality was confined to the first 30 days (HR = 7.44, 95% CI 4.76-11.66, p < 0.01). Conclusion PPMI following TAVI was associated with lower overall survival compared with patients without PPMI. PPMI prognostic impact is restricted to the initial months after the procedure. The analyses were consistent for VARC-2 criteria and for both biomarkers, yet CK-MB was a stronger prognostic marker of mortality than troponin.
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Affiliation(s)
- Mauricio Felippi de Sá Marchi
- Departamento de Cardiologia Intervencionista e Hemodinamica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
- Department of Interventional Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Pedro Calomeni
- Departamento de Cardiologia Intervencionista e Hemodinamica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | | | - Gabriel Kanhouche
- Departamento de Cardiologia Intervencionista e Hemodinamica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Lis Victória Ravani
- Departamento de Cardiologia Intervencionista e Hemodinamica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Caio Vinicius Fernandes Rodrigues
- Departamento de Cardiologia Intervencionista e Hemodinamica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Flávio Tarasoutchi
- Unidade Clinica de Valvopatias, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Fábio Sandoli de Brito
- Departamento de Cardiologia Intervencionista e Hemodinamica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Josep Rodés-Cabau
- Department of Cardiovascular Medicine, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
- Department of Cardiovascular Medicine, Institut Clinic Cardiovascular, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Alexandre Abizaid
- Departamento de Cardiologia Intervencionista e Hemodinamica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Henrique Barbosa Ribeiro
- Departamento de Cardiologia Intervencionista e Hemodinamica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
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Filomena D, Monosilio S, Cimino S, Maestrini V, Luongo F, Neccia M, Salvi N, Colantonio R, Mancone M, Sardella G, Fedele F, Agati L. Prognostic role of pre- and postinterventional myocardial injury in patients undergoing transcatheter aortic valve implantation. Minerva Cardiol Angiol 2023; 71:77-82. [PMID: 33944532 DOI: 10.23736/s2724-5683.21.05630-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic pre-procedural and acute post-procedural myocardial injury are frequently observed in patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The aim of our study was to investigate the prognostic role of high sensitivity cardiac troponins (hs-cTns) elevation before and after TAVI. METHODS 106 patients with severe aortic stenosis who underwent TAVI were enrolled. High sensitivity cardiac troponin T (hs-cTnT) was measured before and after TAVI (6, 24, 48, 72 hours). Post-procedural myocardial damage was defined as a 15-fold rise in hs-cTnT upper reference limit (URL) after TAVI. The clinical endpoints were all cause death, cardiovascular death and re-hospitalization at 24 months follow-up. RESULTS Before TAVI, hs-cTnT median value was 0.03 μg/L (2.3±2.1 fold over URL). After TAVI procedure, myocardial damage (MD), as defined by VARC-2 criteria, was observed in 40 patients (38%) (MD group). In our population, logarithmically transformed hs-cTnTs were independently associated with all-cause mortality at 24 months F/U (pre-TAVI hs-cTnT: Hazard ratio [HR] 2.2, 95% confidence interval [CI]: 1.1 to 4.4, P=0.027). No significant differences were observed between the MD and non-MD groups for the three endpoints of all cause death (p log rank: 0.15), cardiovascular death (p log rank: 0.86) and re-hospitalization (p log rank: 0.87). CONCLUSIONS Only baseline hs-cTnT levels correlated with outcomes at 24 months of follow-up. Chronic pre-procedural myocardial injury significantly affects prognosis after TAVI.
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Affiliation(s)
- Domenico Filomena
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy -
| | - Sara Monosilio
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Sara Cimino
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Federico Luongo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Matteo Neccia
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Nicolò Salvi
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Riccardo Colantonio
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Luciano Agati
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
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Troponin as a predictor of outcomes in transcatheter aortic valve implantation: systematic review and meta-analysis. Gan To Kagaku Ryoho 2023; 71:12-19. [PMID: 36318400 DOI: 10.1007/s11748-022-01888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is emerging as a therapeutic gold standard in the management of aortic stenosis. However, post-procedural complications of this procedure are being increasingly recognised. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated troponin prior to TAVI to predict risk of post-procedural complications. METHODS We searched Medline (Ovid), Embase (Ovid), and the Cochrane Library from inception until May 2022, and included studies on the association between elevated pre-procedural troponin with 30-day mortality, long-term mortality, and post-procedural myocardial injury (PPMI). We generated summary odds ratios (OR) and hazards ratios (HR) using random-effects meta-analysis and performed subgroup analyses to evaluate differences in troponin threshold selection. Inter-study heterogeneity was tested using the I2 test. RESULTS We included 10 studies involving 4200 patients. Serum troponin elevation prior to TAVI was significantly associated with long-term mortality [HR = 2.09 (95% CI 1.30-3.36)], but not with 30-day mortality [OR 1.76 (95% CI 0.96-3.22)]. Subgroup analysis showed a trend towards increased effect size and statistical significance for 30-day mortality as troponin elevation was more narrowly defined. Two studies reported on PPMI and found no statistically significant mean difference between groups. CONCLUSIONS Raised serum troponin is associated with increased long-term mortality following TAVI. Further clarification on the optimal troponin threshold for risk identification is required. High-quality studies that utilise ROC analysis for threshold selection are warranted.
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Guney MC, Keles T, Karaduman BD, Ayhan H, Suygun H, Kahyaoglu M, Bozkurt E. Predictors and Prognostic Implications of Myocardial Injury After Transcatheter Aortic Valve Replacement. Tex Heart Inst J 2022; 49:483735. [PMID: 35838644 DOI: 10.14503/thij-20-7380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Myocardial injury (MI) is not unusual after transcatheter aortic valve replacement (TAVR). To determine precipitating factors and prognostic outcomes of MI after TAVR, we retrospectively investigated relationships between MI after TAVR and aortic root dimensions, baseline patient characteristics, echocardiographic findings, and procedural features. Of 474 patients who underwent transfemoral TAVR for severe aortic stenosis in our tertiary center from June 2011 through June 2018, 188 (mean age, 77.7 ± 7.7 yr; 96 women [51%]) met the study inclusion criteria. Patients were divided into postprocedural MI (PMI) (n=74) and no-PMI (n=114) groups, in accordance with high-sensitivity troponin T levels. We found that MI risk was associated with older age (odds ratio [OR]=1.054; 95% CI, 1.013-1.098; P=0.01), transcatheter heart valve type (OR=10.207; 95% CI, 2.861-36.463; P=0.001), distances from the aortic annulus to the right coronary artery ostium (OR=0.853; 95% CI, 0.731-0.995; P=0.04) and the left main coronary artery ostium (OR=0.747; 95% CI, 0.616-0.906; P=0.003), and baseline glomerular filtration rate (OR=0.985; 95% CI, 0.970-1.000; P=0.04). Moreover, the PMI group had a longer time to hospital discharge (P=0.001) and a higher permanent pacemaker implantation rate (P=0.04) than did the no-PMI group. Our findings may enable better estimation of which patients are at higher risk of MI after TAVR and thus improve the planning and course of clinical care.
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Affiliation(s)
- Murat Can Guney
- Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Telat Keles
- Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bilge Duran Karaduman
- Department of Cardiology, Faculty of Medicine, Atilim University, Medicana International Ankara Hospital, Ankara, Turkey
| | - Huseyin Ayhan
- Department of Cardiology, Faculty of Medicine, Atilim University, Medicana International Ankara Hospital, Ankara, Turkey
| | - Hakan Suygun
- Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Muzaffer Kahyaoglu
- Department of Cardiology, Gaziantep Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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Boxhammer E, Berezin AE, Paar V, Bacher N, Topf A, Pavlov S, Hoppe UC, Lichtenauer M. Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement. J Pers Med 2022; 12:jpm12040603. [PMID: 35455719 PMCID: PMC9026430 DOI: 10.3390/jpm12040603] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
Patients with severe aortic valve stenosis and concomitant pulmonary hypertension show a significantly reduced survival prognosis. Right heart catheterization as a preoperative diagnostic tool to determine pulmonary hypertension has been largely abandoned in recent years in favor of echocardiographic criteria. Clinically, determination of echocardiographically estimated systolic pulmonary artery pressure falls far short of invasive right heart catheterization data in terms of accuracy. The aim of the present systematic review was to highlight noninvasive possibilities for the detection of pulmonary hypertension in patients with severe aortic valve stenosis, with a special focus on cardiovascular biomarkers. A total of 525 publications regarding echocardiography, cardiovascular imaging and biomarkers related to severe aortic valve stenosis and pulmonary hypertension were analyzed in a systematic database analysis using PubMed Central®. Finally, 39 publications were included in the following review. It was shown that the current scientific data situation, especially regarding cardiovascular biomarkers as non-invasive diagnostic tools for the determination of pulmonary hypertension in severe aortic valve stenosis patients, is poor. Thus, there is a great scientific potential to combine different biomarkers (biomarker scores) in a non-invasive way to determine the presence or absence of PH.
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Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Alexander E. Berezin
- Internal Medicine Department, State Medical University of Zaporozhye, 69035 Zaporozhye, Ukraine;
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Nina Bacher
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Sergii Pavlov
- Department of Clinical Laboratory Diagnostics, State Medical University of Zaporozhye, 69035 Zaporozhye, Ukraine;
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
- Correspondence:
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Lahoud RN, Sharma T. Myocardial injury following transcatheter aortic valve replacement: Cause for concern? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:16-18. [PMID: 34872850 DOI: 10.1016/j.carrev.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rony N Lahoud
- University of Vermont Larner College of Medicine, Burlington, VT, USA.
| | - Toishi Sharma
- University of Vermont Larner College of Medicine, Burlington, VT, USA
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Schoechlin S, Schulz U, Ruile P, Hein M, Eichenlaub M, Jander N, Neumann FJ, Valina C. Impact of high-sensitivity cardiac troponin T on survival and rehospitalization after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2021; 98:E881-E888. [PMID: 34076331 DOI: 10.1002/ccd.29781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/20/2021] [Accepted: 05/09/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Constant elevations of the serum concentration of cardiac troponin T (TnT) indicate a myocardial injury that may affect the long-term outcome of transcatheter aortic valve replacement (TAVR). OBJECTIVES We sought to investigate the impact of pre-TAVR TnT on outcomes after TAVR during long-term follow-up. METHODS In a retrospective, observational study we compared long term outcomes after TAVR between tertiles of preinterventional high-sensitivity TnT. Systematic follow-up was performed annually for 5 years. The primary endpoint was a composite of all-cause death and any rehospitalization. RESULTS Between 2010 and 2018, 2,129 patients with severe aortic valve stenosis underwent TAVR at our institution (mean age 82.6 years, 57.2% female, logistic EuroSCORE 20.5 ± 15.8). Boundaries for TnT tertiles were <21 ng/L and >42 ng/L. The median follow-up was 895 days. Three-year incidences for the primary endpoint were 70.9%, 76.6%, and 81.7% in the low, middle, and high tertile (log rank p < .001). Compared with the first tertile, the corresponding adjusted hazard ratios were 1.23 (95%-CI 1.08-1.40, p < .001) and 1.50 (95%-CI 1.32-1.70, p < .001) for the second and third tertile. We found consistent differences between TnT strata for all-cause death (3-year incidences 23.3%, 33.3%, and 47.1%; adjusted p < .001) and rehospitalization (3-year incidences 64.7%, 68.7% and 72.0%; adjusted p < .001), including significant differences in deaths (p < .001). The association between TnT and outcome was independent of coronary artery disease or low aortic valve gradient. CONCLUSIONS TnT before TAVR is strongly associated with all-cause death and rehospitalization during 3-year follow-up.
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Affiliation(s)
- Simon Schoechlin
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Undine Schulz
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Philip Ruile
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Martin Eichenlaub
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Nikolaus Jander
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Christian Valina
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
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9
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White M, Baral R, Ryding A, Tsampasian V, Ravindrarajah T, Garg P, Koskinas KC, Clark A, Vassiliou VS. Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis. Med Sci (Basel) 2021; 9:medsci9020029. [PMID: 34067808 PMCID: PMC8163007 DOI: 10.3390/medsci9020029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
The optimal timing of aortic valve replacement (AVR) remains controversial. Several biomarkers reflect the underlying pathophysiological processes in aortic stenosis (AS) and may be of use as mortality predictors. The aim of this systematic review and meta-analysis is to evaluate the blood biomarkers utilised in AS and assess whether they associate with mortality. PubMed and Embase were searched for studies reporting baseline biomarker level and mortality outcomes in patients with AS. A total of 83 studies met the inclusion criteria and were systematically reviewed. Of these, 21 reporting brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin and Galectin-3 were meta-analysed. Pooled analysis demonstrated that all-cause mortality was significantly associated with elevated baseline levels of BNP (HR 2.59; 95% CI 1.95–3.44; p < 0.00001), NT-proBNP (HR 1.73; 95% CI 1.45–2.06; p = 0.00001), Troponin (HR 1.65; 95% CI 1.31–2.07; p < 0.0001) and Galectin-3 (HR 1.82; 95% CI 1.27–2.61; p < 0.001) compared to lower baseline biomarker levels. Elevated levels of baseline BNP, NT-proBNP, Troponin and Galectin-3 were associated with increased all-cause mortality in a population of patients with AS. Therefore, a change in biomarker level could be considered to refine optimal timing of intervention. The results of this meta-analysis highlight the importance of biomarkers in risk stratification of AS, regardless of symptom status.
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Affiliation(s)
- Madeline White
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
| | - Ranu Baral
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
| | - Alisdair Ryding
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
| | - Vasiliki Tsampasian
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
- Correspondence:
| | - Thuwarahan Ravindrarajah
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
| | | | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
| | - Vassilios S. Vassiliou
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
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Seoudy H, Lambers M, Winkler V, Dudlik L, Freitag-Wolf S, Frank J, Kuhn C, Rangrez AY, Puehler T, Lutter G, Bramlage P, Frey N, Frank D. Elevated high-sensitivity troponin T levels at 1-year follow-up are associated with increased long-term mortality after TAVR. Clin Res Cardiol 2021; 110:421-428. [PMID: 33098469 PMCID: PMC7907029 DOI: 10.1007/s00392-020-01759-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Elevated pre-procedural high-sensitivity troponin T (hs-TnT) levels predict adverse outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). It is unknown whether elevated troponin levels still provide prognostic information during follow-up after successful TAVR. We evaluated the long-term implications of elevated hs-TnT levels found at 1-year post-TAVR. METHODS AND RESULTS The study included 349 patients who underwent TAVR for severe AS from 2010-2019 and for whom 1-year hs-TnT levels were available. Any required percutaneous coronary interventions were performed > 1 week before TAVR. The primary endpoint was survival time starting at 1-year post-TAVR. Optimal hs-TnT cutoff for stratifying risk, identified by ROC analysis, was 39.4 pg/mL. 292 patients had hs-TnT < 39.4 pg/mL (median 18.3 pg/mL) and 57 had hs-TnT ≥ 39.4 pg/mL (median 51.2 pg/mL). The high hs-TnT group had a higher median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, greater left ventricular (LV) mass, higher prevalence of severe diastolic dysfunction, LV ejection fraction < 35%, severe renal dysfunction, and more men compared with the low hs-TnT group. All-cause mortality during follow-up after TAVR was significantly higher among patients who had hs-TnT ≥ 39.4 pg/mL compared with those who did not (mortality rate at 2 years post-TAVR: 12.3% vs. 4.1%, p = 0.010). Multivariate analysis identified 1-year hs-TnT ≥ 39.4 pg/mL (hazard ratio 2.93, 95% CI 1.91-4.49, p < 0.001), NT-proBNP level > 300 pg/mL, male sex, an eGFR < 60 mL/min/1.73 m2 and chronic obstructive pulmonary disease as independent risk factors for long-term mortality after TAVR. CONCLUSIONS Elevated hs-TnT concentrations at 1-year after TAVR were associated with a higher long-term mortality.
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Affiliation(s)
- Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Moritz Lambers
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre Elisabeth-Krankenhaus, Essen, Germany
| | - Vincent Winkler
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
| | - Linnea Dudlik
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
| | - Sandra Freitag-Wolf
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johanne Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Christian Kuhn
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Ashraf Yusuf Rangrez
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Thomas Puehler
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Georg Lutter
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
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11
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Akodad M, Roubille F, Marin G, Lattuca B, Macia JC, Delseny D, Gandet T, Robert P, Schmutz L, Piot C, Maupas E, Robert G, Targosz F, Albat B, Cayla G, Leclercq F. Myocardial Injury After Balloon Predilatation Versus Direct Transcatheter Aortic Valve Replacement: Insights From the DIRECTAVI Trial. J Am Heart Assoc 2020; 9:e018405. [PMID: 33297821 PMCID: PMC7955361 DOI: 10.1161/jaha.120.018405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Myocardial injury is associated with higher mortality after transcatheter aortic valve replacement (TAVR) and might be increased by prior balloon aortic valvuloplasty (BAV). We aimed to evaluate the impact of prior BAV versus direct prosthesis implantation on myocardial injury occurring after (TAVR) with balloon-expandable prostheses. Methods and Results The DIRECTAVI (Direct Transcatheter Aortic Valve Implantation) trial, an open-label randomized study, demonstrated noninferiority of TAVR without BAV (direct TAVR group) compared with systematic BAV (BAV group) with the Edwards SAPIEN 3 valve. High-sensitivity troponin was assessed before and the day after the procedure. Incidence of myocardial injury after the procedure (high-sensitivity troponin elevation >15× the upper reference limit [14 ng/L]) was the main end point. Impact of myocardial injury on 1-month adverse events (all-cause mortality, stroke, major bleeding, major vascular complications, transfusion, acute kidney injury, heart failure, pacemaker implantation, and aortic regurgitation) was evaluated. Preprocedure and postprocedure high-sensitivity troponin levels were available in 211 patients. The mean age of patients was 83 years (78-87 years), with 129 men (61.1%). Mean postprocedure high-sensitivity troponin was 124.9±81.4 ng/L in the direct TAVR group versus 170.4±127.7 ng/L in the BAV group (P=0.007). Myocardial injury occurred in 42 patients (19.9%), including 13 patients (12.2%) in the direct TAVR group and 29 (27.9%) in the BAV group (P=0.004). BAV increased by 2.8-fold (95% CI, 1.4-5.8) myocardial injury probability. Myocardial injury was associated with 1-month adverse events (P=0.03). Conclusions BAV increased the incidence and magnitude of myocardial injury after TAVR with new-generation balloon-expandable valves. Myocardial injury was associated with 1-month adverse events. These results argue in favor of direct SAPIEN 3 valve implantation. Registration URL: https://www.Clinicaltrials.gov; Unique identifier: NCT02729519.
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Affiliation(s)
- Mariama Akodad
- Department of Cardiology Montpellier University Hospital Montpellier France.,PhyMedExp INSERM U1046CNRS UMR 9214 Montpellier France
| | - François Roubille
- Department of Cardiology Montpellier University Hospital Montpellier France.,PhyMedExp INSERM U1046CNRS UMR 9214 Montpellier France
| | - Gregory Marin
- Department of Medical Information Montpellier University Hospital Montpellier France
| | - Benoit Lattuca
- Department of Cardiology CHU NimesMontpellier University Nimes France
| | | | - Delphine Delseny
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Thomas Gandet
- Department of Cardiovascular Surgery University Hospital of Montpellier France
| | - Pierre Robert
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Laurent Schmutz
- Department of Cardiology CHU NimesMontpellier University Nimes France
| | | | | | | | | | - Bernard Albat
- Department of Cardiovascular Surgery University Hospital of Montpellier France
| | - Guillaume Cayla
- Department of Cardiology CHU NimesMontpellier University Nimes France
| | - Florence Leclercq
- Department of Cardiology Montpellier University Hospital Montpellier France
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12
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. Meta-analysis of impact of troponins on mortality after transcatheter aortic valve implantation. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:98-106. [DOI: 10.23736/s0021-9509.19.11023-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Li Y, Pei H, Zhou C, Lou Y. Pre-procedural elevated cardiac troponin predict risk of long-term all-cause mortality after transcatheter aortic valve replacement: a meta-analysis of prospective studies. Biomarkers 2020; 25:164-170. [PMID: 31920111 DOI: 10.1080/1354750x.2020.1714736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yuehua Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanjun Pei
- Department of Cardiology, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Chenghui Zhou
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Lou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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14
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Flechsig M, Ruf TF, Troeger W, Wiedemann S, Quick S, Ibrahim K, Pfluecke C, Youssef A, Sveric KM, Winzer R, Heinzel FR, Linke A, Strasser RH, Zhang K, Heidrich FM. Remote Ischemic Preconditioning Neither Improves Survival nor Reduces Myocardial or Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI). J Clin Med 2020; 9:jcm9010160. [PMID: 31936060 PMCID: PMC7019611 DOI: 10.3390/jcm9010160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/31/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Peri-interventional myocardial injury occurs frequently during transcatheter aortic valve implantation (TAVI). We assessed the effect of remote ischemic preconditioning (RIPC) on myocardial injury, acute kidney injury (AKIN) and 6-month mortality in patients undergoing TAVI. METHODS We performed a prospective single-center controlled trial. Sixty-six patients treated with RIPC prior to TAVI were enrolled in the study and were matched to a control group by propensity-score. RIPC was applied to the upper extremity using a conventional tourniquet. Myocardial injury was assessed using high-sensitive troponin-T (hsTnT), and kidney injury was assessed using serum creatinine levels. Data were compared with the Wilcoxon-Rank and McNemar tests. Mortality was analysed with the log-rank test. RESULTS TAVI led to a significant rise of hsTnT across all patients (p < 0.001). No significant inter-group difference in maximum troponin release or areas-under-the-curve was detected. Medtronic CoreValve and Edwards Sapien valves showed similar peri-interventional troponin kinetics and patients receiving neither valve did benefit from RIPC. AKIN occurred in one RIPC patient and four non-RIPC patients (p = 0.250). No significant difference in 6-month mortality was observed. No adverse events related to RIPC were recorded. CONCLUSION Our data do not show a beneficial role of RIPC in TAVI patients for cardio- or renoprotection, or improved survival.
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Affiliation(s)
- Mandy Flechsig
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden at Technische Universität Dresden, 01307 Dresden, Germany
| | - Tobias F. Ruf
- Center for Cardiology, Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany
| | - Willi Troeger
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden at Technische Universität Dresden, 01307 Dresden, Germany
| | - Stephan Wiedemann
- Department of Internal Medicine and Cardiology, HELIOS Klinikum Pirna, 01796 Pirna, Germany
| | - Silvio Quick
- Department of Cardiology, Klinikum Chemnitz, Technische Universität Dresden, 09116 Chemnitz, Germany
| | - Karim Ibrahim
- Department of Cardiology, Klinikum Chemnitz, Technische Universität Dresden, 09116 Chemnitz, Germany
| | - Christian Pfluecke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden at Technische Universität Dresden, 01307 Dresden, Germany
| | - Akram Youssef
- Department of Cardiology, Klinikum Chemnitz, Technische Universität Dresden, 09116 Chemnitz, Germany
| | - Krunoslav M. Sveric
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden at Technische Universität Dresden, 01307 Dresden, Germany
| | - Robert Winzer
- Department of Radiology, Universitätsklinikum Dresden, 01307 Dresden, Germany
| | - Frank R. Heinzel
- Department of Internal Medicine and Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden at Technische Universität Dresden, 01307 Dresden, Germany
| | - Ruth H. Strasser
- Medical Faculty, Technische Universität Dresden, 01069 Dresden, Germany
| | - Kun Zhang
- Department of Internal Medicine and Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany
- Berlin Health Institute, 10178 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450659746
| | - Felix M. Heidrich
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden at Technische Universität Dresden, 01307 Dresden, Germany
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15
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Sato T, Aizawa Y, Yuasa S, Taya Y, Fujita S, Ikeda Y, Kitazawa H, Takahashi M, Okabe M. The Determinants and Outcomes of Myocardial Injury After Transcatheter Aortic-Valve Implantation: SAPIEN 3 Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:973-979. [PMID: 31924486 DOI: 10.1016/j.carrev.2019.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/29/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The effect of myocardial injury (MI) post-transcatheter aortic valve implantation (TAVI) on clinical outcomes is controversial. This study aimed to evaluate the effect of MI severity on clinical outcome and left ventricle function 30 days post-TAVI and determine MI post-TAVI predictors. METHODS Overall, 138 consecutive patients who underwent successful transfemoral TAVI using SAPIEN3 and diagnosed using echocardiography and computed tomography were analyzed. High-sensitivity cardiac troponin T (TnT) was evaluated at baseline, immediately, and at 24, 48, and 72 h post-TAVI. Echocardiography findings and N-terminal pro-B-type natriuretic peptide (Nt-pro BNP) levels were evaluated 30 days post-TAVI. RESULTS Mean age and STS score were 84.4 ± 3.5 years and 6.4 ± 3.2%, respectively. All cases showed severe aortic valve stenosis. Peri-procedural MI was observed in 48 of 100 patients (48.0%). Patients were grouped into MI (n = 48) and non-MI (n = 52), without significant difference in characteristics. Pre-balloon aortic valvuloplasty rate and total pacing time were significantly higher in MI vs non-MI. Total rapid pacing time (TRPT) was an independent predictor for MI (OR 1.06; 95% CI 1.01-1.16; p = 0.04). Echocardiography and Nt-pro BNP changes 30 days post-TAVI were similar between groups. CONCLUSION Peri-procedural MI, assessed by TnT changes, was observed in 48% of patients. The MI was not associated with overt cardiac dysfunction, and the recovery of left ventricular function and Nt-pro BNP level occurred similarly by 30 day post-TAVI between both groups. In multivariate analysis, TRPT was associated with MI after SAPIEN3 implantation. TRIAL REGISTRATION NUMBER UMIN000036669.
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Affiliation(s)
- Takao Sato
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan.
| | | | - Sho Yuasa
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan
| | - Yuji Taya
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan
| | | | - Yoshio Ikeda
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan
| | | | | | - Masaaki Okabe
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan
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16
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Okyay K, Sadıç BÖ, Şahinarslan A, Durakoğlugil ME, Karabay CY, Eryüksel SE, Gülbahar Ö, Tekin A, Yıldırır A, Görenek B, Yavuzgil O, Fak AS. Turkish Society of Cardiology consensus paper on the rational use of cardiac troponins in daily practice. Anatol J Cardiol 2019; 21:331-344. [PMID: 31073114 PMCID: PMC6683230 DOI: 10.14744/anatoljcardiol.2019.42247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 01/23/2023] Open
Affiliation(s)
- Kaan Okyay
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey.
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17
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Toutouzas K, Stathogiannis K, Latsios G, Synetos A, Drakopoulou M, Penesopoulou V, Michelongona A, Tsiamis E, Tousoulis D. Biomarkers in Aortic Valve Stenosis and their Clinical Significance in Transcatheter Aortic Valve Implantation. Curr Med Chem 2019; 26:864-872. [PMID: 28748765 DOI: 10.2174/0929867324666170727110241] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 11/30/2016] [Accepted: 12/17/2016] [Indexed: 02/06/2023]
Abstract
Aortic valve stenosis is one of the most common valvular heart disorders and the prevalence will rise as the population ages. Once symptomatic patients with aortic valve stenosis tend to fare worse with high mortality rates. Aortic valve replacement is indicated in these patients and besides the standard surgical replacement, a less invasive approach, transcatheter aortic valve implantation, has gained momentum and has showed promising and solid results in patients with high surgical risk. An important aspect of evaluating patients with aortic valve stenosis is the ability to choose the best possible candidate for the procedure. In addition, predicting the short and long-term clinical outcomes after the valve replacement could offer the treating physicians a better insight and provide information for optimal therapy. Biomarkers are biological parameters that can be objectively measured and evaluated as indicators of normal biological processes and are easily monitored. The aim of this review is to critically assess some of the most widely used biomarkers at present (natriuretic peptides, troponins, C-reactive protein) and provide an insight in novel biomarkers that are currently being investigated (galectin-3, growth differentiation factor-15, microRNAs) for possible diagnostic and prognostic use in aortic valve stenosis and transcatheter aortic valve implantation respectively.
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Affiliation(s)
- Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - George Latsios
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Vicky Penesopoulou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Eleftherios Tsiamis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
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18
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Akodad M, Spaziano M, Chevalier B, Garot P, Benamer H, Dinan‐Zannier A, Troussier X, Unterseeh T, Champagne S, Hovasse T, Lefèvre T. Prognostic Impact of Pre-Transcatheter and Post-Transcatheter Aortic Valve Intervention Troponin: A Large Cohort Study. J Am Heart Assoc 2019; 8:e011111. [PMID: 30866687 PMCID: PMC6475053 DOI: 10.1161/jaha.118.011111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
Background Biomarkers were advocated as prognostic factors in patients undergoing transcatheter aortic valve intervention, with contradictory results concerning prognostic impact of troponin. Our aim was to assess the prognostic impact of preprocedural and postprocedural troponin in transcatheter aortic valve intervention. Methods and Results Preprocedural and postprocedural high-sensitivity troponin levels were measured in all patients undergoing transcatheter aortic valve intervention. Primary end point was 1-year mortality. This study included 1390 patients, with a mean age of 83.4±6.8 years. Patients were divided into 3 tertiles according to preprocedural troponin values: tertile 1: 0.001 to 0.023 μg/L; tertile 2: 0.024 to 1.80 μg/L; and T3: 1.81 to 12.1 μg/L. One-year mortality was higher in patients in tertile 2 (hazard ratio, 2.1; P=0.001) and T3 (hazard ratio, 1.8; P=0.009) compared with those in tertile 1. Myocardial injury was predictive of 1-year mortality (hazard ratio, 1.7; P=0.01). This effect may be stronger in the tertile 1 subgroup (hazard ratio, 5.1; P=0.03 [ P value for interaction: 0.18]). Conclusions Elevated preprocedural troponin and myocardial injury are associated with 1-year mortality after transcatheter aortic valve intervention.
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Affiliation(s)
- Mariama Akodad
- Interventional Cardiology DepartmentRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
| | - Marco Spaziano
- Interventional Cardiology DepartmentRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
| | - Bernard Chevalier
- Interventional Cardiology DepartmentRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
| | - Philippe Garot
- Interventional Cardiology DepartmentRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
| | - Hakim Benamer
- Interventional Cardiology DepartmentRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
| | | | - Xavier Troussier
- Intensive Care UnitRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
| | - Thierry Unterseeh
- Interventional Cardiology DepartmentRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
| | - Stéphane Champagne
- Interventional Cardiology DepartmentRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
| | - Thomas Hovasse
- Interventional Cardiology DepartmentRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
| | - Thierry Lefèvre
- Interventional Cardiology DepartmentRamsay Générale de SantéInstitut Cardiovasculaire Paris SudMassyFrance
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19
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Ludman PF. Cardiac Marker Release During Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2018; 11:e007454. [PMID: 30571216 DOI: 10.1161/circinterventions.118.007454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham University Hospitals NHS Foundation Trust, United Kingdom
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20
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Nara Y, Watanabe Y, Kataoka A, Nakashima M, Hioki H, Nagura F, Kawashima H, Konno K, Kyono H, Yokoyama N, Kozuma K. Incidence, Predictors, and Midterm Clinical Outcomes of Myocardial Injury After Transcatheter Aortic-Valve Implantation. Int Heart J 2018; 59:1296-1302. [DOI: 10.1536/ihj.17-645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yugo Nara
- Department of Medicine, Teikyo University School of Medicine
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine
| | - Akihisa Kataoka
- Department of Medicine, Teikyo University School of Medicine
| | | | - Hirofumi Hioki
- Department of Medicine, Teikyo University School of Medicine
| | - Fukuko Nagura
- Department of Medicine, Teikyo University School of Medicine
| | | | - Kumiko Konno
- Department of Medicine, Teikyo University School of Medicine
| | - Hiroyuki Kyono
- Department of Medicine, Teikyo University School of Medicine
| | | | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine
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21
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Michail M, Cameron JN, Nerlekar N, Ihdayhid AR, McCormick LM, Gooley R, Niccoli G, Crea F, Montone RA, Brown AJ. Periprocedural Myocardial Injury Predicts Short- and Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2018; 11:e007106. [DOI: 10.1161/circinterventions.118.007106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Michael Michail
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Melbourne, Australia (M.M., N.N., A.R.I., L.M.M., R.G., A.J.B.)
- Institute of Cardiovascular Science, University College London, United Kingdom (M.M.)
| | | | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Melbourne, Australia (M.M., N.N., A.R.I., L.M.M., R.G., A.J.B.)
| | - Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Melbourne, Australia (M.M., N.N., A.R.I., L.M.M., R.G., A.J.B.)
| | - Liam M. McCormick
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Melbourne, Australia (M.M., N.N., A.R.I., L.M.M., R.G., A.J.B.)
| | - Robert Gooley
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Melbourne, Australia (M.M., N.N., A.R.I., L.M.M., R.G., A.J.B.)
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (G.N., F.C., R.A.M.)
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (G.N., F.C., R.A.M.)
| | - Rocco A. Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (G.N., F.C., R.A.M.)
| | - Adam J. Brown
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Melbourne, Australia (M.M., N.N., A.R.I., L.M.M., R.G., A.J.B.)
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22
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Mirna M, Wernly B, Eder S, Lichtenauer M, Prinz E, Wintersteller W, Jung C, Hoppe U, Hammerer M. Transcatheter aortic valve implantation without prior balloon valvuloplasty is associated with less pronounced markers of myocardial injury. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:243-249. [PMID: 30303343 DOI: 10.23736/s0021-9509.18.10651-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aortic valve stenosis is the most common valvulopathy in developed countries. Transcatheter aortic valve implantation (TAVI) is a therapeutic alternative in symptomatic patients at high or prohibitive perioperative risk. Predilatation by balloon aortic valvuloplasty (BAV) under rapid ventricular pacing (RVP) has been a routine part of TAVI. However, both RVP and BAV carry substantial risks and an increasing number of interventional centers are performing TAVI without predilatation (direct TAVI). A transient decrease of left ventricular function and elevated markers of myocardial injury after TAVI with predilatation were observed in previous studies. In this study, we investigated whether direct TAVI was associated with a similar increase in cardiac biomarkers and decrease in ejection fraction in a cohort of our patients. METHODS Consecutive patients undergoing TAVI without predilatation using a self-expanding system at a single center between April 2013 and December 2015 were followed up for one year and were retrospectively analyzed regarding mortality, safety and efficacy endpoints as well as common laboratory and echocardiographic parameters. RESULTS A total of 164 patients (83±6 years; 56% female) were included in the analysis. According to the Valve Academic Research Consortium 2 (VARC-2) criteria the technical success rate was 96.3% and 89.1% of patients remained free of a combined safety endpoint at 30 days. Mortality rates at 30 days and 1 year were 3.0% (N.=5) and 10.4% (N.=17), respectively. TAVI without predilatation was highly effective in lowering aortic valve peak velocity from 4.4±0.6 m/s before to 1.7±0.5 m/s (P<0.01), and mean pressure gradient across the valve from 48.7±15.1 mmHg to 8.3±4.5 mmHg (<0.05). Left ventricular function remained unaltered after the intervention (51±10% prior to TAVI and 51±9% post TAVI), whereas high sensitive troponin T (hs-TnT), a well-established marker for myocardial injury, increased significantly from 26 ng/L (interquartile range=18.00-44.00) to 119 ng/L (interquartile range=73.25-166.00, P<0.001) during this time. Notably, an increase in the plasma levels of hs-TnT >15 times the upper limit of normal was associated with mortality both one month and one year after TAVI. CONCLUSIONS TAVI without predilatation is feasible, safe and effective for aortic valve replacement in symptomatic patients with severe aortic stenosis who are at high perioperative risk. In contrast to a cohort of patients who underwent TAVI with predilatation previously published by another center, our patients did not suffer from transient impairment of left ventricular function. As a marker of myocardial injury, hs-TnT showed a less pronounced increase than reported previously. This might be a marker for a prognostic benefit as hs-TnT has been shown to be a strong predictor of outcome in patients undergoing TAVI. We conclude that direct TAVI is a less invasive option involving less myocardial stress.
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Affiliation(s)
- Moritz Mirna
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Sarah Eder
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Erika Prinz
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Wilfried Wintersteller
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - Uta Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Matthias Hammerer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria -
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23
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Transient elevation of high-sensitive troponin T after Cardioband implantation. Herz 2018; 44:546-552. [DOI: 10.1007/s00059-018-4754-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/08/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
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24
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Oury C, Nchimi A, Lancellotti P, Bergler-Klein J. Can Blood Biomarkers Help Predicting Outcome in Transcatheter Aortic Valve Implantation? Front Cardiovasc Med 2018; 5:31. [PMID: 29644220 PMCID: PMC5882866 DOI: 10.3389/fcvm.2018.00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/16/2018] [Indexed: 12/14/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become the method of choice for patients with severe aortic valve stenosis, who are ineligible or at high risk for surgery. In this high risk patient population, early and late mortality and rehospitalization rates after TAVI are still relatively high. In spite of recent improvements in procedural TAVI, and establishment of risk models for poor outcome, determining individual risk remains challenging. In this context, current data from several small studies strongly suggest that blood biomarkers of myocardial injury, cardiac mechanical stretch, inflammation, and hemostasis imbalance might play an important role by providing informations on patient risk at baseline, and postprocedural progression of patient clinical conditions from days up to years post-TAVI. Although the role of biomarkers for predicting survival post-TAVI remains to be validated in large randomized studies, implementing biomarkers in clinical practice might improve risk stratification, thereby further reducing TAVI-associated morbidity and mortality.
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Affiliation(s)
- Cécile Oury
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Alain Nchimi
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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25
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Kofler M, Reinstadler SJ, Stastny L, Dumfarth J, Reindl M, Wachter K, Rustenbach CJ, Müller S, Feuchtner G, Mende M, Friedrich G, Metzler B, Grimm M, Bonaros N, Baumbach H. Prognostic Implications of Pre-Procedural High-Sensitivity Cardiac Troponin T in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:2345-2346. [DOI: 10.1016/j.jcin.2017.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 08/31/2017] [Accepted: 09/13/2017] [Indexed: 12/25/2022]
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26
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Liebetrau C, Kim WK, Meyer A, Arsalan M, Gaede L, Blumenstein JM, Fischer-Rasokat U, Wolter JS, Dörr O, Schillinger S, Troidl C, Nef HM, Hamm CW, Walther T, Möllmann H. Identification of Periprocedural Myocardial Infarction Using a High-Sensitivity Troponin I Assay in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:1180-1186. [PMID: 28826900 DOI: 10.1016/j.amjcard.2017.06.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
Periprocedural myocardial infarction (MI), a rare complication after transcatheter aortic valve implantation (TAVI), is associated with worse outcome. According to the Valve Academic Research Consortium (VARC-2), MI is defined by an increase in cardiac troponin (cTn) and creatine kinase MB (CK-MB) levels; however, many patients show periprocedurally elevated cTn without clinical evidence of MI. The aims of this study were to establish reference values of cardiac troponin I measured with a high-sensitivity assay (hs-cTnI) and to assess the periprocedural diagnostic value of this biomarker in patients who underwent TAVI. Hs-cTnI and CK-MB levels were assessed before and up to 3 days after transfemoral (TF) or transapical (TA) TAVI in 515 patients. A high proportion (61.2%) of patients had elevated hs-cTnI at baseline. According to VARC-2 criteria, almost all TA-patients (99.5%) showed an MI based on hs-cTnI compared with 4.2% based on CK-MB. In TF-patients, 81.1% had an MI based on hs-cTnI compared with 9.0% based on CK-MB. Only 10 patients (2%), however, had a type 1 MI. The ninety-ninth percentile for hs-cTnI was 285 ng/L in the TAVI cohort. After applying a TAVI-specific cutoff the frequency of MI was lower and more realistic (TF: 5% vs 81.1%; p <0.001; TA: 22.2% vs 99.5%; p <0.001). In conclusion, the VARC-2 definition leads to an overestimation of periprocedural MI. Our new TAVI-specific reference values yield a more realistic estimation of the myocardial ischemic risk. hs-cTnI, however, does not seem to be the biomarker of choice for MI detection in this setting.
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27
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Forrest JK, Hermany PL. Biomarkers in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:1561-1563. [DOI: 10.1016/j.jcin.2017.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 11/24/2022]
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28
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Heger T, Strauß S, Blessing E, Andrassy M, Erbel C, Müller OJ, Chorianopoulos E, Pleger S, Leuschner F, Korosoglou G, Bekeredjian R, Katus HA, Vogel B. Short and long-term results after endovascular management of vascular complications during transfemoral aortic valve implantation. Acta Cardiol 2017; 72:474-482. [PMID: 28705072 DOI: 10.1080/00015385.2017.1335455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Vascular injury and access site complications in the contemporary setting of transcatheter aortic valve implantation (TAVI) are known to be associated with increased mortality and morbidity. The aim of our study was to analyse the feasibility and safety of percutaneous treatment of such vascular complications using a stent graft. Methods Between January 2010 and April 2013, 36 TAVI patients developed severe access site complications and underwent subsequent interventional treatment with a covered stent. Acute treatment success was confirmed by angiography immediately after the implantation of the stent graft, with clinical long-term patency follow-up being assessed by duplex ultrasound. Results Of the 36 patients evaluated, percutaneous treatment of the acute access site bleeding was successful in 35 patients (97%), with one patient requiring surgical intervention due to insufficient haemostasis after stent graft implantation. A subset of 5 patients underwent successful ipsilateral stent graft implantation, either because crossover sheath placement was not feasible (n = 1), or intentionally with an even sheathless approach in an effort to reduce vessel injury (n = 4). After a mean follow-up of 22 ± 8 months, stent graft patency was confirmed by duplex ultrasound in 13 patients with an additional 5 patients reporting to be free from symptoms and claudication. Thirteen patients died within the first 24 months after the procedure, however, none was due to access vessel complications. Five patients were lost for follow-up. Conclusions Our data confirm that endovascular treatment of access site complications related to TAVI is feasible, safe and efficacious, resulting in long-term vascular patency.
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Affiliation(s)
- Thomas Heger
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefanie Strauß
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Christian Erbel
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver J. Müller
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Emmanuel Chorianopoulos
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sven Pleger
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Leuschner
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Raffi Bekeredjian
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Britta Vogel
- Department of Cardiology, Angiology, and Pulmology, Heidelberg University Hospital, Heidelberg, Germany
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29
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High sensitivity troponin and valvular heart disease. Trends Cardiovasc Med 2017; 27:326-333. [DOI: 10.1016/j.tcm.2017.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 11/23/2022]
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30
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Redfors B, Furer A, Lindman BR, Burkhoff D, Marquis-Gravel G, Francese DP, Ben-Yehuda O, Pibarot P, Gillam LD, Leon MB, Généreux P. Biomarkers in Aortic Stenosis: A Systematic Review. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1329959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Björn Redfors
- Cardiovascular Research Foundation, New York, NY, USA
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ariel Furer
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, NY, USA
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | | | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, NY, USA
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Philippe Pibarot
- Pulmonary Hypertension and Vascular Biology Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Québec, Canada
| | - Linda D. Gillam
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Martin B. Leon
- Cardiovascular Research Foundation, New York, NY, USA
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA
- Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
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31
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Okitsu K, Iritakenishi T, Imada T, Iwasaki M, Shibata SC, Fujino Y. A longer total duration of rapid ventricular pacing does not increase the risk of postprocedural myocardial injury in patients who undergo transcatheter aortic valve implantation. Heart Vessels 2017; 32:1117-1122. [PMID: 28321573 DOI: 10.1007/s00380-017-0965-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Abstract
Rapid ventricular pacing (RVP) is used during transcatheter aortic valve implantation (TAVI). RVP disturbs myocardial oxygen balance, and when prolonged, it may cause procedure-related myocardial injury (PMI). This study investigated whether a longer duration of RVP increased the occurrence of PMI or worsened long-term mortality after TAVI. We retrospectively analyzed data from 188 patients who underwent TAVI in our institute from January 2013 to July 2015. Myocardial injury was represented by the peak value of creatine kinase-myocardial band (CK-MB) within 72 h after the procedure; an increase greater than 5 times the upper reference limit was regarded as PMI. There was no difference in RVP time (RVPT) between patients with and without PMI (median [range]: 57 [9-189] s vs. 54 [0-159] s, p = 0.9). A higher peak CK-MB was significantly correlated with the apical approach for the procedure (p < 0.001) but not with total RVPT (p = 0.22). A subanalysis of 133 patients whose troponin I was tested within 72 h postprocedurally showed no correlation between the peak value and RVPT (p = 0.40). Shortening RVPT did not result in myocardial protection; thus, RVPT during TAVI should be sufficient to optimize valve placement.
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Affiliation(s)
- Kenta Okitsu
- Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan.
| | - Takeshi Iritakenishi
- Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Tatsuyuki Imada
- Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Mitsuo Iwasaki
- Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Sho Carl Shibata
- Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
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32
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Köhler WM, Freitag-Wolf S, Lambers M, Lutz M, Niemann PM, Petzina R, Lutter G, Bramlage P, Frey N, Frank D. Preprocedural but not periprocedural high-sensitive Troponin T levels predict outcome in patients undergoing transcatheter aortic valve implantation. Cardiovasc Ther 2017; 34:385-396. [PMID: 27380819 DOI: 10.1111/1755-5922.12208] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM Risk assessment of patients undergoing transcatheter aortic valve implantation (TAVI) remains difficult. Biomarkers have been shown to provide potential prognostic information. Here, we aimed to analyze whether the biomarker high-sensitivity Troponin T (hsTNT) could be used to improve risk stratification. METHOD We prospectively enrolled 267 patients undergoing TAVI. Biomarkers (hsTNT and NTproBNP) were measured 1 day before, and 3 and 7 days postprocedure. All possible prognostic factors upon survival time were analyzed by Cox regression analysis. RESULTS A total of 259 patients (mean age 82±6.1 years) were available for complete follow-up. The median Logistic EuroSCORE (Log ES) and Log ES II were 21.16% (Q1=13.92; Q3=34.27) and 6.42% (Q1=3.89; Q3=11.07), respectively. Median follow-up was 290 (Q1=88; Q3=529) days. A total of 71 deaths occurred during follow-up, and the 30-day mortality was 5.8%. Median baseline hsTNT was 27.4 pg/mL (Q1=16.2; Q3=46 pg/mL). From all potential mortality-associated factors, only preprocedural hsTNT level (P=.001), elevated Log ES (P=.03) as well as acute kidney injury (P<.001) and chronic obstructive pulmonary disease (COPD) (P=.039) emerged as independent prognostic parameters for adverse outcome. We also tested whether the Valve Academic Research Consortium-2 (VARC-II) cutoff for myocardial damage (hsTNT peak value exceeding 15× the upper reference limit + at least 50% increase) was of prognostic relevance. At 72-hours post-TAVI, 36.2% of the patients matched these VARC-II criteria of myocardial damage. However, these patients did not display a difference in survival compared to patients without significant myocardial injury. CONCLUSION Elevated preprocedural hsTNT represents an independent risk predictor of all-cause death while periprocedural hsTNT elevation failed to show prognostic relevance.
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Affiliation(s)
- Wiebke M Köhler
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Moritz Lambers
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Lutz
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Philip Maximilian Niemann
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rainer Petzina
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Mahlow, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
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Al-Rashid F, Kahlert P, Selge F, Hildebrandt H, Patsalis PC, Totzeck M, Mummel P, Rassaf T, Jánosi RA. Risk Assessment of Patients Undergoing Transfemoral Aortic Valve Implantation upon Admission for Post-Interventional Intensive Care and Surveillance: Implications on Short- and Midterm Outcomes. PLoS One 2016; 11:e0167072. [PMID: 27880819 PMCID: PMC5120839 DOI: 10.1371/journal.pone.0167072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/13/2016] [Indexed: 12/05/2022] Open
Abstract
Background Several studies have found that standard risk scores inaccurately reflect risk in TAVI cohorts. The assessment of mortality risk upon post-interventional ICU admission is important to optimizing clinical management. This study sought to determine outcomes and factors affecting mortality in patients admitted to the intensive care unit (ICU) after transcatheter aortic valve implantation (TAVI), and to analyze and compare the predictive values of SAPS II and EuroSCORE. Methods and Findings 214 consecutive patients treated with transfemoral TAVI (2006–2012) admitted to the ICU in an academic tertiary-care university hospital, were included in this retrospective data analysis. The overall 30-day mortality rate was 7%. Non-survivors at 30-days and survivors showed differences in the rates of catecholamine therapy upon ICU admission (93 vs. 29%; p<0.001), stroke (20 vs. 1%;p<0.001), sepsis (27 vs. 2%;p<0.001), kidney injury (83 vs. 56%; log-rank p<0.001), catecholamine therapy (88 vs. 61%;log-rank p<0.001) and vascular complications (60 vs. 17%; p<0.001). Mean SAPS II score and predicted mortality were higher in non-survivors (38.1±7.0 vs. 29.9±6.2;p<0.001 and 23.1±11.7 vs. 10.5±8.2;p<0.001, retrospectively), whereas the logistic EuroSCORE could not discriminate between the groups (p = 0.555). Among the biochemical parameters, the maximum values of creatinine, procalcitonin, and troponin I during the first 48 h after ICU admission were significantly higher in non-survivors. Multivariate analysis of baseline characteristics and complications associated with two-year mortality showed no significant results. Conclusions The SAPS II is a good tool for estimating ICU mortality immediately after performing the TAVI procedure and provides valuable information for other known predictors of mortality.
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Affiliation(s)
- Fadi Al-Rashid
- Department of Cardiology of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Philipp Kahlert
- Department of Cardiology of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Friederike Selge
- Department of Cardiology of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Heike Hildebrandt
- Department of Cardiology of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Polycarpos-Christos Patsalis
- Department of Cardiology of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Petra Mummel
- Department of Neurology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
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Lo J, Hill C. Intensive care unit management of transcatheter aortic valve recipients. Semin Cardiothorac Vasc Anesth 2016; 19:95-105. [PMID: 25975594 DOI: 10.1177/1089253215575183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe aortic stenosis is an increasingly prevalent disease that continues to be associated with significant mortality. Transcatheter aortic valve replacements have been used as an alternative to surgical aortic valve replacement in high-risk patients with multiple comorbidities. In this review, we discuss postoperative considerations pertinent to the successful management of these complicated patients in the intensive care unit.
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Affiliation(s)
- Joyce Lo
- Stanford University, Stanford, CA, USA
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35
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Kim WK, Liebetrau C, van Linden A, Blumenstein J, Gaede L, Hamm CW, Walther T, Möllmann H. Myocardial injury associated with transcatheter aortic valve implantation (TAVI). Clin Res Cardiol 2015; 105:379-87. [PMID: 26670909 DOI: 10.1007/s00392-015-0949-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an important treatment option for elderly patients with symptomatic aortic stenosis whose risk is too high or prohibitive for conventional surgery. Despite notable progress during the past decade, continuous efforts directed at further improvement of procedural safety and performance are required, especially considering expanding indications for interventional treatment options among lower-risk populations. One issue that needs to be addressed is myocardial damage, which can frequently be observed after TAVI and has been linked to worse prognosis. Yet, knowledge concerning the underlying mechanisms and clinical impact remains scarce, and further investigation in this field is warranted. In this review, we provide a contemporary summary of the types of myocardial injury associated with TAVI, including access-related injury, mechanical trauma and ischemia, the role of myocardial biomarkers, and the impact on left ventricular function, with emphasis on potential mechanisms and clinical implications.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Arnaud van Linden
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Johannes Blumenstein
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Luise Gaede
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.,Department of Cardiology, University of Giessen, Giessen, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.
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Krau NC, Lünstedt NS, Freitag-Wolf S, Brehm D, Petzina R, Lutter G, Bramlage P, Dempfle A, Frey N, Frank D. Elevated growth differentiation factor 15 levels predict outcome in patients undergoing transcatheter aortic valve implantation. Eur J Heart Fail 2015; 17:945-55. [DOI: 10.1002/ejhf.318] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/08/2015] [Accepted: 06/16/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Nora-Christina Krau
- Department of Internal Medicine III (Cardiology and Angiology); University Hospital Schleswig-Holstein; Campus Kiel Germany
| | - Nina-Sophie Lünstedt
- Department of Internal Medicine III (Cardiology and Angiology); University Hospital Schleswig-Holstein; Campus Kiel Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics; University Hospital Schleswig-Holstein; Campus Kiel Germany
| | - Doreen Brehm
- Department of Internal Medicine III (Cardiology and Angiology); University Hospital Schleswig-Holstein; Campus Kiel Germany
| | - Rainer Petzina
- Department of Cardiac and Vascular Surgery; University Hospital Schleswig-Holstein; Campus Kiel Germany
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery; University Hospital Schleswig-Holstein; Campus Kiel Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck; Kiel Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine; Mahlow Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics; University Hospital Schleswig-Holstein; Campus Kiel Germany
| | - Norbert Frey
- Department of Internal Medicine III (Cardiology and Angiology); University Hospital Schleswig-Holstein; Campus Kiel Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck; Kiel Germany
| | - Derk Frank
- Department of Internal Medicine III (Cardiology and Angiology); University Hospital Schleswig-Holstein; Campus Kiel Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck; Kiel Germany
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37
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Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR. Clin Res Cardiol 2015; 104:964-74. [DOI: 10.1007/s00392-015-0865-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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Shirakabe A, Kobayashi N, Hata N, Yamamoto M, Shinada T, Tomita K, Tsurumi M, Matsushita M, Okazaki H, Yamamoto Y, Yokoyama S, Asai K, Shimizu W. Prognostic impact of the serum heart-type fatty acid-binding protein (H-FABP) levels in patients admitted to the non-surgical intensive care unit. Clin Res Cardiol 2014; 103:791-804. [DOI: 10.1007/s00392-014-0717-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/15/2014] [Indexed: 12/24/2022]
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Geis NA, Chorianopoulos E, Kallenbach K, André F, Pleger ST, Karck M, Katus HA, Bekeredjian R. Feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters. Clin Res Cardiol 2014; 103:775-80. [PMID: 24748131 DOI: 10.1007/s00392-014-0713-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/04/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We intended to show feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters. BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a valid treatment option in patients with aortic valve stenosis who are poor candidates for surgical aortic valve replacement. Few patients, who cannot undergo transfemoral or transsubclavian aortic valve implantation due to small access vessel diameters, are not suitable for transapical or direct aortic valve implantation, either. METHODS In more than 700 transcatheter aortic valve implantations since 2008 we identified 17 patients who had to be excluded from transfemoral valve implantation due to vessel diameters <6 mm and who were no candidates for transapical or direct aortic implantation. We performed CoreValve™ implantations in these patients without the required 18F sheath to cross the vessels despite their small size (4.6-5.9 mm). RESULTS Sixteen sheathless implantations were successful. In all 17 patients, bleeding during the procedure due to the smaller delivery catheter was minimal. Sixteen patients had a successful access site closure at the end of the procedure. CONCLUSIONS Sheathless implantation of a self-expanding aortic valve can be safely considered in selected patients with access vessel diameters below 6 mm, if transapical or direct aortic implantation is not suitable.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Haussig S, Schuler G, Linke A. Worldwide TAVI registries: what have we learned? Clin Res Cardiol 2014; 103:603-12. [PMID: 24648061 DOI: 10.1007/s00392-014-0698-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/03/2014] [Indexed: 01/27/2023]
Abstract
With a rapidly aging society, the number of patients with cardiovascular disease-in particular aortic stenosis-is progressively increasing. Although conventional aortic valve replacement remains the only treatment known to improve prognosis and symptoms in symptomatic patients with aortic stenosis, about one-third are still withhold from the life-saving therapy. Based on the compelling evidence of the randomized Placement of Aortic transcatheter valves (PARTNER) A and B cohort, TAVI is now considered standard of care for extreme risk and inoperable patients and is an alternative to surgery for high-risk patients with symptomatic aortic stenosis. However, these patients were super-selected, which does not reflect a clinical real-world situation. TAVI registries represent a real-world scenario, and therefore provide the evidence for the treatment of high-risk patients (regarding comorbidities and anatomical factors) in daily clinical life. The review will focus on the recently published Edwards SAPIEN, Medtronic CoreValve and mixed (national) registries with the focus on short- and midterm outcome. These registries suggest that the growing experience of the operators with regard to patient selection, prevention, recognition and treatment of procedural complications together with the developments in valve design will improve the short-term results of TAVI. However, randomized trials in intermediate risk patients and data on long-term valve durability are a prerequisite before indications can be expanded to younger and lower risk patient population.
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Affiliation(s)
- Stephan Haussig
- Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany
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Development of a risk score for outcome after transcatheter aortic valve implantation. Clin Res Cardiol 2014; 103:631-40. [PMID: 24643728 DOI: 10.1007/s00392-014-0692-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
AIMS Transcatheter aortic valve implantation (TAVI) is an increasingly common procedure in elderly and multimorbid patients with aortic stenosis. We aimed at developing a pre-procedural risk evaluation scheme beyond current surgical risk scores. METHODS We developed a risk algorithm for 1-year mortality in two cohorts consisting of 845 patients undergoing routine TAVI procedures by commercially available devices, mean age 80.9 ± 6.5, 51 % women. Clinical variables were determined at baseline. Multivariable Cox regression related clinical data to mortality (n = 207 deaths). RESULTS To account for variability related to age and sex and by enrolment site we forced age, sex, and cohort into the score model. Body mass index, estimated glomerular filtration rate, hemoglobin, pulmonary hypertension, mean transvalvular gradient and left ventricular ejection fraction at baseline were most strongly associated with mortality and entered the risk prediction algorithm [C-statistic 0.66, 95 % confidence interval (CI) 0.61-0.70, calibration χ (2)-statistic = 6.51; P = 0.69]. Net reclassification improvement compared to existing surgical risk predication schemes was positive. The score showed reasonable model fit and calibration in external validation in 333 patients, N = 55 deaths (C-statistic 0.60, 95 % CI 0.52-0.68; calibration χ (2)-statistic = 16.2; P = 0.06). Additional measurement of B-type natriuretic peptide and troponin I did not improve the C-statistic. Frailty increased the C-statistic to 0.71, 95 % CI 0.65-0.76. CONCLUSIONS We present a new risk evaluation tool derived and validated in routine TAVI cohorts that predicts 1-year mortality. Biomarkers only marginally improved risk prediction. Frailty increased the discriminatory ability of the score and needs to be considered. Risk algorithms specific for TAVI may help to guide decision-making when patients are evaluated for TAVI.
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