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Puehler T, Pommert NS, Freitag-Wolf S, Seoudy H, Ernst M, Haneya A, Sathananthan J, Sellers SL, Meier D, Schöttler J, Müller OJ, Salehi Ravesh M, Saad M, Frank D, Lutter G. Tricuspid Regurgitation and TAVR: Outcomes, Risk Factors and Biomarkers. J Clin Med 2024; 13:1474. [PMID: 38592316 PMCID: PMC10934629 DOI: 10.3390/jcm13051474] [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: 10/12/2023] [Revised: 01/20/2024] [Accepted: 01/29/2024] [Indexed: 04/10/2024] Open
Abstract
Background. The significance of concomitant tricuspid regurgitation (TR) in the context of transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to analyze the severity of TR before and after TAVR with regard to short- and long-term survival and to analyze the influencing factors. Methods. In our retrospective analysis, TR before and after TAVR was examined and patients were classified into groups accordingly. Special attention was paid to patients with post-interventional changes in TR. Mortality after TAVR was considered the primary endpoint of the analysis and major complications according to the Valve Academic Research Consortium 3 (VARC3) were compared. Moreover, biomarkers and risk factors for worsening or improvement of TR through TAVR were analyzed. Results. Among 775 patients who underwent TAVR in our center between January 2009 and December 2019, 686 patients (89%) featured low- and 89 patients (11%) high-grade TR. High-grade pre-TAVR TR was associated with worse short- (30-day), mid- (2-year) and long-term survival up to 8 years. Even though in nearly half of the patients with high-grade TR the regurgitation improved within seven days after TAVR (n = 42/89), this did not result in a survival benefit for this subgroup. On the other hand, a worsening of low-grade TR was seen in more than 10% of the patients (n = 73/686), which was also associated with a worse prognosis. Predictors of worsening of TR after TAVR were adipositas, impaired right ventricular function and the presence of mild TR. Age, atrial fibrillation, COPD, impaired renal function and elevated cardiac biomarkers were risk factors for mortality after TAVR independent from the grade of TR. Conclusions. Not only pre-interventional, but also post-TAVR high-grade TR is associated with a worse prognosis after TAVR. TAVR can change concomitant tricuspid regurgitation, but improvement does not have any impact on short- and long-term survival. Worsening of TR after TAVR is possible and impairs the prognosis.
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Affiliation(s)
- Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, D-24105 Kiel, Germany; (N.S.P.); (M.E.); (J.S.); (G.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany; (O.J.M.); (D.F.)
| | - Nina Sophie Pommert
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, D-24105 Kiel, Germany; (N.S.P.); (M.E.); (J.S.); (G.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany; (O.J.M.); (D.F.)
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany;
| | - Hatim Seoudy
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany; (H.S.); (M.S.)
| | - Markus Ernst
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, D-24105 Kiel, Germany; (N.S.P.); (M.E.); (J.S.); (G.L.)
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, D-24105 Kiel, Germany; (N.S.P.); (M.E.); (J.S.); (G.L.)
| | - Janarthanan Sathananthan
- Center for Heart Valve Innovation & Cardiovascular Translational Laboratory, St Paul’s Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (J.S.); (S.L.S.); (D.M.)
| | - Stephanie L. Sellers
- Center for Heart Valve Innovation & Cardiovascular Translational Laboratory, St Paul’s Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (J.S.); (S.L.S.); (D.M.)
| | - David Meier
- Center for Heart Valve Innovation & Cardiovascular Translational Laboratory, St Paul’s Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (J.S.); (S.L.S.); (D.M.)
| | - Jan Schöttler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, D-24105 Kiel, Germany; (N.S.P.); (M.E.); (J.S.); (G.L.)
| | - Oliver J. Müller
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany; (O.J.M.); (D.F.)
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany; (H.S.); (M.S.)
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany;
| | - Mohammed Saad
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany; (H.S.); (M.S.)
| | - Derk Frank
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany; (O.J.M.); (D.F.)
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany; (H.S.); (M.S.)
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, D-24105 Kiel, Germany; (N.S.P.); (M.E.); (J.S.); (G.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany; (O.J.M.); (D.F.)
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Salama A, Ibrahim G, Fikry M, Elsannan MH, Eltahlawi M. Prognostic value of high-sensitive troponin T in patients with severe aortic stenosis undergoing valve replacement surgery. Indian J Thorac Cardiovasc Surg 2024; 40:142-150. [PMID: 38389769 PMCID: PMC10879475 DOI: 10.1007/s12055-023-01594-5] [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: 03/20/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 02/24/2024] Open
Abstract
Background Aortic stenosis (AS) is a well-known cause of mortality. We aimed to assess the prognostic value of high-sensitive troponin T (hs-TnT) in symptomatic patients with severe AS and preserved left ventricular ejection fraction (LVEF) after surgical aortic valve replacement (AVR). Patients and methods The study recruited patients with severe symptomatic AS fulfilling the inclusion criteria in the period between April 2020 and February 2022. Comprehensive echocardiography was done. The following parameters were assessed: AS severity, LV mass index (LVMI), left atrium volume index (LAVI), and LVEF. E/e' and LVEF were calculated using the biplane method of Simpsons. Global longitudinal strain (GLS) was assessed by speckle tracking echocardiography. Peripheral blood samples were collected for hs-TnT measurement. All patients underwent surgical AVR. The patients were followed for the following 6 months for major adverse cardiovascular events (MACE). MACE was defined as cardiac death, re-admission for congestive heart failure (CHF) and fatal arrhythmia. Results One hundred and eight patients (mean age = 58.7 ± 7.68 years) with severe AS were recruited. Seventeen patients presented with MACE including 8 cardiac deaths. We divided the patients into two groups based on the normal hs-TnT values. The Kaplan-Meier curve revealed a statistically significant difference in MACE rate among troponin groups (log-rank test = 5.06, p = 0.025). There was significant difference between both groups regarding GLS with smaller GLS in negative hs-TnT group. In multivariate analysis, GLS and hs-TnT were significantly associated with MACE (p = 0.022 and < 0.01 respectively). The cutoff value of hs-TnT of 238.25 had a sensitivity of 70% and a specificity of 81% for predicting future MACE. There was a significant correlation between GLS and troponin (p < 0.001). Conclusions hs-TnT is associated with bad short-term prognosis after AVR. hs-TnT and GLS could be significant predictors for future MACE in patients with severe symptomatic AS and preserved LVEF who underwent AVR. Elevated hs-TnT and impaired GLS could set an indication of early intervention in asymptomatic severe AS.
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Affiliation(s)
- Alaa Salama
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Ghada Ibrahim
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Mohammad Fikry
- Cardiology Department, Zagazig University, Zagazig, Egypt
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Gong Z, Xing D, Wu R, Zhang S, Ye C, Chen Y, Liu X, Chen L, Wang T. Prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease undergoing cardiac surgery: a systematic review and meta-analysis of cohort studies. Cardiovasc Diagn Ther 2022; 12:853-867. [PMID: 36605072 PMCID: PMC9808115 DOI: 10.21037/cdt-22-155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/09/2022] [Indexed: 01/09/2023]
Abstract
Background To perform an updated and comprehensive meta-analysis on the prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease (CHD) undergoing cardiac surgery. Methods A systematic search was conducted until September 2021 for relevant studies published in PubMed, Web of Science Database and Embase. Based on the average values, NT-proBNP concentrations were classified as high and low levels. The outcomes of interest were mortality, cardiovascular events, and other postoperative outcomes. A random-effects model was used to calculate composite risk estimates and corresponding 95% confidence intervals (CIs). Possible sources of heterogeneity and stability of results were analyzed using subgroup and sensitivity analyses. Results A total of 32 studies published between 2008 and 2021 involving 7,571 participants were included. Results showed CHD patients at high NT-proBNP levels yielded an increased risk of mortality [risk ratio (RR) =1.14; 95% CI: 1.08-1.20] and cardiovascular events (RR =2.02; 95% CI: 1.26-3.24) compared with those at low NT-proBNP levels. No significant association was found between NT-proBNP and risks for other postoperative outcomes in CHD patients undergoing cardiac surgery (RR =1.73; 95% CI: 0.86-3.47). Significant heterogeneity was detected across studies regarding these risk estimates. Subgroup analysis found heterogeneity in the risk estimate of mortality was explained by geographic region, type of CHD, and assay method of NT-proBNP. Sensitivity analysis supported the robustness of results. Conclusions Compared with CHD patients at low NT-proBNP levels, CHD patients at high NT-proBNP levels had elevated risks of mortality and cardiovascular events. Further large-scale and well-controlled studies are needed to confirm our findings.
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Affiliation(s)
- Ziqiang Gong
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Dexiu Xing
- Medical Records Statistics Room of Medical Affair Department, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Rong Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Changxiang Ye
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yan Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiaoling Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China;,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China;,National Health Commission Key Laboratory for Birth Defect Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
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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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Imamura T, Oshima A, Narang N, Onoda H, Tanaka S, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Clinical implications of troponin-T elevations following TAVR: Troponin Increase Following TAVR. J Cardiol 2021; 79:240-246. [PMID: 34538533 DOI: 10.1016/j.jjcc.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Baseline and post-procedural elevations in serum troponin-T levels are associated with increased morbidity and mortality following transcatheter aortic valve replacement (TAVR). However, the prognostic impact of change in serum troponin-T level following TAVR remains unknown. METHODS Among the patients with severe aortic stenosis who underwent TAVR, those with baseline serum troponin-T level ≥51.5 ng/L were excluded. The impact of increases in serum troponin-T level to an abnormally high range (≥51.5 ng/L) following TAVR on 2-year cardiovascular death or heart failure readmissions was investigated. RESULTS Among 189 included patients (median 86 years old, 28% men), serum troponin-T level increased in 79 patients following TAVR. An increase in serum troponin-T was associated with a higher rate of 30-day adverse events, predominantly due to pacemaker implantation for complete atrio-ventricular block, and a higher 2-year cumulative incidence of the primary endpoint (hazard ratio 5.24, 95% confidence interval 1.64-16.8, p = 0.005) adjusted for the potential confounders. CONCLUSION Post-procedural increase in serum troponin-T level was associated with adverse clinical outcomes following TAVR.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
| | - Akira Oshima
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | | | - Hiroshi Onoda
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Shuhei Tanaka
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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