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de Sá Marchi MF, Rosa VEE, Nicz PFG, Fonseca JHDAPD, Calomeni P, Chiodini F, Sampaio RO, Pomerantzeff PMA, Vieira MDC, Tarasoutchi F, Van Mieghem NM, Brito FSD, Abizaid A, Ribeiro HB. Myocardial Injury After Transcatheter Mitral Valve Replacement Versus Surgical Reoperation. Am J Cardiol 2024; 214:8-17. [PMID: 38104756 DOI: 10.1016/j.amjcard.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/28/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
This study aimed to evaluate the incidence and clinical implications of myocardial injury, as determined by cardiac biomarker increase, in patients who underwent mitral bioprosthesis dysfunction treatment with transcatheter mitral valve replacement (TMVR) versus surgical mitral valve replacement reoperation (SMVR-REDO). Between 2014 and 2023, 310 patients with mitral bioprosthesis failure were included (90 and 220 patients for TMVR and SMVR-REDO, respectively). Multivariable analysis and propensity score matching were performed to adjust for the intergroup differences in baseline characteristics. Creatinine kinase-MB (CK-MB) and cardiac troponin I (cTn) were collected at baseline and 6 to 12, 24, 48, and 72 hours after intervention. The cardiac biomarkers values were evaluated in relation to their reference values. The outcomes were determined according to the Mitral Valve Academic Research Consortium criteria. CK-MB and cTn increased above the reference level in almost all patients after SMVR-REDO and TMVR (100% vs 94%, respectively), with the peak occurring within 6 to 12 hours. SMVR-REDO was associated with a two- to threefold higher increase in cardiac biomarkers. After 30 days, the mortality rates were 13.3% in the TMVR and 16.8% in the SMVR-REDO groups. At a median follow-up of 19 months, the mortality rates were 21.1% in the TMVR and 17.7% in the SMVR-REDO groups. Left ventricular ejection fraction, estimated glomerular filtration rate, CK-MB, and cTn were predictors of mortality. In conclusion, some degree of myocardial injury occurred systematically after the treatment of mitral bioprosthetic degeneration, especially after SMVR, and higher CK-MB and cTn levels were associated with increased cumulative late mortality, regardless of the approach.
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Affiliation(s)
- Mauricio Felippi de Sá Marchi
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil; Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vitor Emer Egypto Rosa
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Pedro Felipe Gomes Nicz
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | | | - Pedro Calomeni
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Fernando Chiodini
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Roney Orismar Sampaio
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Pablo Maria Alberto Pomerantzeff
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Marcelo de Campos Vieira
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Flávio Tarasoutchi
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Fábio Sandoli de Brito
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Alexandre Abizaid
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Henrique Barbosa Ribeiro
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil.
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Yuan B, Huang X, Wen J, Peng M. Dexmedetomidine Pretreatment Confers Myocardial Protection and Reduces Mechanical Ventilation Duration for Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass. Ann Thorac Cardiovasc Surg 2024; 30:23-00210. [PMID: 38684422 PMCID: PMC11082494 DOI: 10.5761/atcs.oa.23-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE The study aims to assess the effects of dexmedetomidine (Dex) pretreatment on patients during cardiac valve replacement under cardiopulmonary bypass. METHODS For patients in the Dex group (n = 52), 0.5 μg/kg Dex was given before anesthesia induction, followed by 0.5 μg/kg/h pumping injection before aortic occlusion. For patients in the control group (n = 52), 0.125 ml/kg normal saline was given instead of Dex. RESULTS The patients in the Dex group had longer time to first dose of rescue propofol than the control group (P = 0.003). The Dex group required less total dosage of propofol than the control group (P = 0.0001). The levels of cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), malondialdehyde (MDA), and tumor necrosis factor-α (TNF-α) were lower in the Dex group than the control group at T4, 8 h after the operation (T5), and 24 h after the operation (T6) (P <0.01). The Dex group required less time for mechanical ventilation than the control group (P = 0.003). CONCLUSION The study suggests that 0.50 µg/kg Dex pretreatment could reduce propofol use and the duration of mechanical ventilation, and confer myocardial protection without increased adverse events during cardiac valve replacement.
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Affiliation(s)
- Binglin Yuan
- Department of Anesthesiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Xiqiang Huang
- Department of Anesthesiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Junlin Wen
- Department of Anesthesiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Mengzhe Peng
- Pharmacy Intravenous Admixture Services, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
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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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Kim HN, Yang DH, Park BE. Acute decompensated heart failure after transcatheter aortic valve implantation: A case report. Clin Case Rep 2023; 11:e7597. [PMID: 37484748 PMCID: PMC10362099 DOI: 10.1002/ccr3.7597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
Transcatheter aortic valve implantation (TVAI) is a widely used treatment modality for severe aortic stenosis. The complication rates of the procedure have gradually decreased over time, owing to the improvements in procedural skills and development of TVAI devices. However, several rare but serious complications can still occur after TAVI. We recently encountered acute decompensated heart failure as a rare and fatal complication of TAVI and would like to share our experience.
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Affiliation(s)
- Hong Nyun Kim
- Division of Cardiology, Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- Division of Cardiology, Department of Internal MedicineKyungpook National University Chilgok HospitalDaeguKorea
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguKorea
| | - Dong Heon Yang
- Division of Cardiology, Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguKorea
| | - Bo Eun Park
- Division of Cardiology, Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguKorea
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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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Chen W, Han Y, Wang C, Chen W. Association between periprocedural myocardial injury and long-term all-cause mortality in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. SCAND CARDIOVASC J 2022; 56:387-393. [PMID: 36317197 DOI: 10.1080/14017431.2022.2139412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/23/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Objective. The purpose of this meta-analysis was to investigate the effect of periprocedural myocardial injury (PPMI) on long-term all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR) and to explore potential factors associated with mortality risk. Design. The PubMed, Embase, and Cochrane Library databases were searched up to April 2022. Studies reporting the effect of PPMI on the risk of long-term all-cause mortality were included. The summary odds ratio (OR) was calculated using a random effects model. Additionally, meta-regression and subgroup analyses were conducted according to specific research characteristics to explore sources of heterogeneity. Results. Fourteen studies involving 6,415 patients who underwent TAVR showed that the occurrence of PPMI was associated with a higher risk of long-term mortality. Subgroup analysis showed that in the group of aged ≥82 years, men accounted for less than 50%, coronary artery disease patients accounted for more than 50%, and the proportion of patients with chronic kidney disease accounted for more than 60%, the proportion of patients with atria fibrillation accounted for less than 30%, and the Society of Thoracic Surgeons predicted risk of mortality score was >8 points, patients with PPMI had higher long-term all-cause mortality than those without PPMI. Conclusions. Among the patients who underwent TAVR, those who developed PPMI had higher long-term all-cause mortality.
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Affiliation(s)
- Wentao Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yilong Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Chunlin Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenqiang Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
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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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Vincent F, Thourani VH, Ternacle J, Redfors B, Cohen DJ, Hahn RT, Li D, Crowley A, Webb JG, Mack MJ, Kapadia S, Russo M, Smith CR, Alu MC, Leon MB, Pibarot P. Time-of-Day and Clinical Outcomes After Surgical or Transcatheter Aortic Valve Replacement: Insights From the PARTNER Trials. Circ Cardiovasc Qual Outcomes 2022; 15:e007948. [PMID: 35041482 DOI: 10.1161/circoutcomes.121.007948] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Circadian rhythms may influence myocardial tolerance to ischemia-reperfusion phenomena occurring during cardiac procedures. While conflicting results exist on the effect of time-of-day on surgical aortic valve replacement (SAVR), afternoon procedures could be associated with a reduced risk of death, rehospitalization or periprocedural myocardial infarction, compared with morning procedures. We examined the impact of procedure time-of-day on outcomes after transcatheter aortic valve replacement (TAVR) or SAVR. METHODS We analyzed patients at intermediate- or high-surgical risk who underwent elective TAVR (n=4457) or SAVR (n=1129) in the PARTNER (Placement of Aortic Transcatheter Valve) 1 and 2 trials and registries according to time-of-day (morning versus afternoon) using the Kaplan-Meier event rates and multivariable Cox proportional hazards regression models. Sensitivity analysis was conducted using 1:1 propensity-score matching. The primary end point was all-cause death or rehospitalization at 2 years. RESULTS At 2 years, no difference was observed between patients operated in the morning versus the afternoon within the SAVR (32.3% versus 30.6%, adjusted hazard ratio, 1.08 [95% CI, 0.82-1.41], P=0.58) and TAVR cohorts (35.7% versus 35.4%, adjusted hazard ratio, 1.01 [95% CI, 0.89-1.14], P=0.86) with regards to the primary end point. Rates of periprocedural myocardial infarction were low and similar between morning and afternoon in SAVR (1.6% versus 1.0%, P=0.51) and TAVR (0.4% versus 0.4%, P=0.86), as were all other clinical end points. Similar results were observed in propensity-score matched analysis. CONCLUSIONS Procedure time-of-day was not associated with clinical outcomes after TAVR or SAVR. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00530894, NCT01314313, NCT03222141, and NCT03222128.
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Affiliation(s)
- Flavien Vincent
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., P.P.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Julien Ternacle
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., P.P.)
| | - Bjorn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.)
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine (D.J.C.)
| | - Rebecca T Hahn
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.T.H., C.R.S., M.C.A., M.B.L.)
| | - Ditian Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.)
| | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.)
| | - John G Webb
- Saint Paul's Hospital, Vancouver, Canada (J.G.W.)
| | - Michael J Mack
- Department of Cardiovascular Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (S.K.)
| | - Mark Russo
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick (M.R.)
| | - Craig R Smith
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.T.H., C.R.S., M.C.A., M.B.L.)
| | - Maria C Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.).,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.T.H., C.R.S., M.C.A., M.B.L.)
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.).,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.T.H., C.R.S., M.C.A., M.B.L.)
| | - Philippe Pibarot
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., P.P.)
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9
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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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Schindler M, Stöckli F, Brütsch R, Jakob P, Holy E, Michel J, Manka R, Vogt P, Templin C, Kasel M, Ruschitzka F, Stähli BE. Postprocedural Troponin Elevation and Mortality After Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2021; 10:e020739. [PMID: 34713705 PMCID: PMC8751831 DOI: 10.1161/jaha.120.020739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background This study sought to investigate the role of postprocedural troponin elevations in mortality prediction after transcatheter aortic valve implantation and to define the threshold at which clinically relevant postprocedure myocardial injury determines mortality. Methods and Results A total of 1333 consecutive patients with transcatheter aortic valve implantation with available postprocedural high‐sensitivity cardiac troponin T measurements were included in the analysis. The threshold at which postprocedure myocardial injury determines long‐term mortality was identified using restricted cubic spline analysis. A >18.3‐fold increase of troponin above the upper reference limit was identified as threshold for relevant postprocedure myocardial injury. Associations remained significant in a landmark analysis between 30 days and 2 years (hazard ratio [HR], 1.61, [95% CI, 1.13–2.28]; P=0.01), after adjusting for known confounders (adjusted HR, 1.90 [95% CI, 1.40–2.57]; P<0001), and in subgroups of patients with coronary artery disease (adjusted HR, 2.17 [95% CI, 1.44–3.29]; P<0.001), renal dysfunction (adjusted HR, 1.88 [95% CI, 1.35–2.62]; P<0.001), and intermediate/high surgical risk (adjusted HR, 2.70 [95% CI, 1.40–5.22]; P=0.003). Conclusions This study determined a troponin threshold for the identification of patients at increased mortality risk after transcatheter aortic valve implantation. The proposed definition of postprocedure myocardial injury advances risk stratification in patients with transcatheter aortic valve implantation and may assist in postprocedural patient management.
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Affiliation(s)
- Matthias Schindler
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Florin Stöckli
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Rico Brütsch
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Philipp Jakob
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Erik Holy
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Jonathan Michel
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Robert Manka
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Paul Vogt
- Cardiac Surgery University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Christian Templin
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Markus Kasel
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Frank Ruschitzka
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Barbara E Stähli
- Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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11
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De Marzo V, Crimi G, Vercellino M, Benenati S, Pescetelli F, Della Bona R, Sarocchi M, Canepa M, Balbi M, Porto I. Impact of bioprosthetic valve type on peri-procedural myocardial injury and mortality after transcatheter aortic valve replacement. Heart Vessels 2021; 36:1746-1755. [PMID: 33963455 PMCID: PMC8481174 DOI: 10.1007/s00380-021-01861-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
Peri-procedural myocardial injury (PPMI) is a common complication after transcatheter valve replacement (TAVR), often remaining clinically silent. The role of valve type on PPMI and the association between PPMI and mortality are still unclear. We sought to evaluate predictors and outcome of PPMI after TAVR, and the impact of self-expandable valve (SEV) vs. balloon-expandable valve (BEV) deployment on PPMI. Consecutive patients who underwent successful TAVR in a single-center from January 2014 to December 2019 were included. PPMI was defined according to a modified Valve Academic Research Consortium (VARC)-2 definition as a post-procedure elevation of troponin (with a peak value ≥ 15-times the upper-reference limit) < 72 h after TAVR. We included 596 patients, of whom 258 (43.3%) were men. Mean age was 83.4 ± 5.5 years. We deployed 368 (61.7%) BEV and 228 (38.3%) SEV. PPMI was observed in 471 (79.0%) patients. At multivariable analysis, SEV (OR 2.70, 95% CI 1.64-4.55, p < 0.001), creatinine clearance (OR 0.98, 95% CI 0.97-1.00, p = 0.011), and baseline ejection fraction (OR 1.05, 95% CI 1.02-1.07, p < 0.001) were independent predictors of PPMI; these findings were also confirmed using a propensity-weighted analysis. Thirty-day and 1-year all-cause mortality rates were 2.5% and 8.1%, respectively. No associations between PPMI and 30-day (p = 0.488) or 1-year (p = 0.139) all-cause mortality were found. Independent predictors of 30-day mortality were increasing EUROSCORE II (HR 1.16 per score point, 95% CI 1.08-1.19, p < 0.001) and life-threatening/major bleeding complications (HR 5.87, 95% CI 1.28-26.58, p = 0.019), whereas EUROSCORE II (HR 1.08, 95% CI 1.04-1.13, p = 0.031) and acute kidney injury (HR 2.59, 95% CI 1.20-5.35, p = 0.020) were related to 1-year mortality. PPMI is frequent after TAVR, but it does not affect 30-day or 1-year all-cause mortality. SEV implantation is associated with an increased frequency of PPMI.
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Affiliation(s)
- Vincenzo De Marzo
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Gabriele Crimi
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Vercellino
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Stefano Benenati
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Fabio Pescetelli
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Roberta Della Bona
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Sarocchi
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Marco Canepa
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Manrico Balbi
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Italo Porto
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy. .,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy.
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12
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Dagan M, Dawson LP, Stehli J, Koh JQS, Quine E, Stub D, Htun NM, Walton A, Duffy SJ. Periprocedural myocardial injury and coronary artery disease in patients undergoing transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:8-15. [PMID: 33863658 DOI: 10.1016/j.carrev.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND/PURPOSE PPMI and CAD are common in patients undergoing TAVR. Despite several studies evaluating their interaction as well as the influence these factors play on outcomes, there remains no consensus. We sought to evaluate the impact of peri-procedural myocardial injury (PPMI) and incidental coronary artery disease (iCAD) on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS/MATERIALS We analyzed prospective data from 400 patients undergoing TAVI for severe aortic stenosis between 2008 and 2018 to determine rates of PPMI (troponin 15× the upper limit of normal) and iCAD (≥50% stenosis) and their impact on long-term mortality. RESULTS Mean age was 83 ± 6 years; 45% were female. PPMI was observed in 65% (254/400). On multivariable logistic regression analysis, higher left ventricular ejection fraction (LVEF) (OR 1.04, 95%CI 1.01-1.06, p = 0.002), and first generation valves (OR 3.00, 95%CI 1.75-5.15, p < 0.001) were independently associated with PPMI, while oral anticoagulation was inversely associated (OR 0.48, 95%CI 0.28-0.82, p = 0.007). PPMI was not associated with 30-day, 1-year or long-term mortality. After excluding previous bypass grafting, iCAD was observed in 40% (129/324). In patients with iCAD, PCI was associated with reduced long-term mortality compared to medical management in adjusted analysis (OR 0.37, 95%CI 0.16-0.88, p = 0.03). CONCLUSIONS PPMI and iCAD in patients undergoing TAVR are common. PPMI is associated with older generation valves and higher LVEF rather than traditional cardiovascular risk factors. In our study, PPMI was not associated with long-term mortality. However, in patients with iCAD, PCI was associated with reduced long-term mortality compared to medical management.
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Affiliation(s)
- Misha Dagan
- Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - Luke P Dawson
- Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
| | - Julia Stehli
- Department of Cardiology, Alfred Hospital, Victoria, Australia
| | | | - Edward Quine
- Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nay M Htun
- Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Hospital, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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13
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Early hemodynamic changes after transcatheter aortic valve implantation in patients with severe aortic stenosis measured by invasive pressure volume loop analysis. Cardiovasc Interv Ther 2020; 37:191-201. [PMID: 33313960 PMCID: PMC8789710 DOI: 10.1007/s12928-020-00737-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022]
Abstract
Replacement of a stenotic aortic valve reduces immediately the ventricular to aortic gradient and is expected to improve diastolic and systolic left ventricular function over the long term. However, the hemodynamic changes immediately after valve implantation are so far poorly understood. Within this pilot study, we performed an invasive pressure volume loop analysis to describe the early hemodynamic changes after transcatheter aortic valve implantation (TAVI) with self-expandable prostheses. Invasive left ventricular pressure volume loop analysis was performed in 8 patients with aortic stenosis (mean 81.3 years) prior and immediately after transfemoral TAVI with a self-expandable valve system (St. Jude Medical Portico Valve). Parameters for global hemodynamics, afterload, contractility and the interaction of the cardiovascular system were analyzed. Left ventricular ejection fraction, (53.9% vs. 44.8%, p = 0.018), preload recruitable stroke work (68.5 vs. 44.8 mmHg, p = 0.012) and end-systolic elastance (3.55 vs. 2.17, p = 0.036) both marker for myocardial contractility declined significantly compared to baseline. As sign of impaired diastolic function, TAU, a preload-independent measure of isovolumic relaxation (37.3 vs. 41.8 ms, p = 0.018) and end-diastolic pressure (13.1 vs. 16.4 mmHg, p = 0.015) raised after valve implantation. Contrarily, a smaller ratio of end-systolic to arterial elastance (ventricular-arterial coupling) indicates an improvement of global cardiovascular energy efficiency (1.40 vs. 0.97 p = 0.036). Arterial elastance had a strong correlation with the number of conducted rapid ventricular pacings (Pearson correlation coefficient, r = 0.772, p = 0.025). Invasive left ventricular pressure volume loop analysis revealed impaired systolic and diastolic function in the early phase after TAVI with self-expandable valve for the treatment of severe aortic stenosis. Contrarily, we found indications for early improvement of global cardiovascular energy efficiency.
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14
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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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15
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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 2020; 8:e011111. [PMID: 30866687 PMCID: PMC6475053 DOI: 10.1161/jaha.118.011111] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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. See Editorial by Charitakis and Nguyen
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Affiliation(s)
- Mariama Akodad
- 1 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Marco Spaziano
- 1 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Bernard Chevalier
- 1 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Philippe Garot
- 1 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Hakim Benamer
- 1 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Annabelle Dinan-Zannier
- 2 Intensive Care Unit Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Xavier Troussier
- 2 Intensive Care Unit Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Thierry Unterseeh
- 1 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Stéphane Champagne
- 1 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Thomas Hovasse
- 1 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
| | - Thierry Lefèvre
- 1 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France
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16
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Barbash IM, Valdebenito M. Editorial: Myocardial Injury After Transcatheter Aortic Valve Replacement: A Factor Not Fully Understood. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:980-981. [PMID: 32507696 DOI: 10.1016/j.carrev.2020.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Israel M Barbash
- Interventional Cardiology Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Martín Valdebenito
- Interventional Cardiology Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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17
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Lugo LM, Romaguera R, Gómez-Hospital JA, Ferreiro JL. Antithrombotic Therapy After Transcatheter Aortic Valve Implantation. Eur Cardiol 2020; 15:1-8. [PMID: 32180830 PMCID: PMC7066806 DOI: 10.15420/ecr.2019.10] [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] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/10/2019] [Indexed: 12/25/2022] Open
Abstract
The development of transcatheter aortic valve implantation has represented one of the greatest advances in the cardiology field in recent years and has changed clinical practice for patients with aortic stenosis. Despite the continuous improvement in operators’ experience and techniques, and the development of new generation devices, thromboembolic and bleeding complications after transcatheter aortic valve implantation remain frequent, and are a major concern due to their negative impact on prognosis in this vulnerable population. In addition, the optimal antithrombotic regimen in this scenario is not known, and current recommendations are mostly empirical and not evidence based. The present review aims to provide an overview of the current status of knowledge, including relevant on-going randomised trials, on antithrombotic treatment strategies after transcatheter aortic valve implantation.
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Affiliation(s)
- Leslie Marisol Lugo
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, University of Western Australia, Perth, Australia
| | - Rafael Romaguera
- Heart Diseases Institute, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Antoni Gómez-Hospital
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, CIBER-CV, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Ferreiro
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, CIBER-CV, L'Hospitalet de Llobregat, Barcelona, Spain
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18
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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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19
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Rahhab Z, Labarre Q, Nijenhuis VJ, El Faquir N, de Biase C, Philippart R, Heijmen R, Kardys I, Dumonteil N, de Jaegere P, van der Heijden J, Tchetche D, Van Mieghem NM. Myocardial Injury Post Transcatheter Aortic Valve Implantation Comparing Mechanically Expanded Versus Self-Expandable Versus Balloon-Expandable Valves. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1639234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Zouhair Rahhab
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Quentin Labarre
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Nahid El Faquir
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Chiara de Biase
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Robin Heijmen
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Peter de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan van der Heijden
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Nicolas M. Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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20
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Sharma V, Dey T, Sankaramangalam K, Alansari SAR, Williams L, Mick S, Krishnaswamy A, Svensson LG, Kapadia S. Prognostically Significant Myocardial Injury in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2019; 8:e011889. [PMID: 31267799 PMCID: PMC6662140 DOI: 10.1161/jaha.118.011889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Troponin elevation occurs commonly in the setting of transcatheter aortic valve replacement (TAVR). There is a lack of information on the extent of troponin elevation post TAVR that is prognostically significant. We assessed the optimal cutoff for post‐TAVR troponin T elevation that correlates with long‐term mortality. We also examined the relationship between coronary artery disease (CAD) and prognostically significant myocardial injury in TAVR. Methods and Results This is a retrospective, observational single‐center study involving patients who underwent TAVR at Cleveland Clinic between 2010 and 2015. Five hundred ten patients were included (mean follow‐up of 2.6±1.3 years). Receiver operating characteristic analysis showed that troponin T elevation ≥3× upper limit of normal was the best predictor of long‐term mortality post TAVR with area under the curve of 0.57, with transapical TAVR patients excluded. Multivariate analyses confirmed that troponin T elevation ≥3× upper limit of normal was significantly associated with increased long‐term mortality post TAVR (hazard ratio 1.57, CI 1.04–2.38, P=0.03). The most common causes for the presence of unrevascularized CAD included the presence of chronic total occlusion in the native/graft vessels (49.7%) and diffuse/complex CAD unsuitable for PCI (24.6%). The presence of unrevascularized CAD and significant left main disease correlated with increased mortality, but not with the presence of prognostically significant myocardial injury. Conclusions Troponin T elevation of ≥3× upper limit of normal is associated with increased long‐term mortality after TAVR, except for the transapical approach. This prognostically significant myocardial injury does not appear to be secondary to severe CAD/unrevascularized CAD or left main disease, but rather is associated with other factors such as post‐TAVR complications.
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Affiliation(s)
- Vikram Sharma
- 1 Department of Hospital Medicine The Cleveland Clinic Cleveland OH
| | - Tanujit Dey
- 2 Department of Quantitative Health Sciences Lerner Research Institute The Cleveland Clinic Cleveland OH
| | - Kesavan Sankaramangalam
- 3 Department of Cardiovascular Medicine, Heart and Vascular Institute The Cleveland Clinic Cleveland OH
| | | | - Louis Williams
- 4 Department of Internal Medicine The Cleveland Clinic Cleveland OH
| | - Stephanie Mick
- 5 Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute The Cleveland Clinic Cleveland OH
| | - Amar Krishnaswamy
- 3 Department of Cardiovascular Medicine, Heart and Vascular Institute The Cleveland Clinic Cleveland OH
| | - Lars G Svensson
- 5 Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute The Cleveland Clinic Cleveland OH
| | - Samir Kapadia
- 3 Department of Cardiovascular Medicine, Heart and Vascular Institute The Cleveland Clinic Cleveland OH
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21
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T wave positivity in lead aVR is associated with mortality after transcatheter aortic valve implantation. ACTA ACUST UNITED AC 2019; 4:e55-e62. [PMID: 31211271 PMCID: PMC6549042 DOI: 10.5114/amsad.2019.84449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/31/2019] [Indexed: 12/03/2022]
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (SAVR) in patients with increased comorbidity. Lead aVR in surface ECG has valuable information about prediction of mortality in many cardiovascular diseases. Our aim was to determine the relationship between ischemic changes in lead aVR and mortality in TAVI patients. Material and methods We retrospectively examined 86 patients with TAVI. The ST segment deviation in lead aVR (STaVR) and T wave polarity (TPaVR) on surface ECG were measured. The absolute values of TPaVR and STaVR were calculated. A ratio (TP/STaVR or vice versa) was obtained from the division of the larger absolute value by the smaller one. Results The patients were divided into two groups as living and deceased. The living group had 68 patients, and the deceased group had 18 patients. The number of positive TPaVR patients after TAVI, TPaVR after TAVI, and TP/STaVR ratio after TAVI were significantly higher in the deceased group. The deceased group had a significantly shorter aortic annulus-LMCA distance. Presence of positive TPaVR (OR = 8.765, 95% CI: 1.088–70.618, p = 0.041), aortic annulus-LMCA distance (for each 1 mm increase, OR = 0.306, 95% CI: 0.158–0.595, p < 0.001) and TP/STaVR ratio (for each 0.1 increase, OR = 1.966, 95% CI: 1.276–3.024, p = 0.002) were determined as independent predictors for mortality. Conclusions Ischemic changes in lead aVR may provide valuable information about mortality after TAVI.
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22
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Baumbach H, Schairer ER, Wachter K, Rustenbach C, Ahad S, Stan A, Hill S, Bramlage P, Franke UFW, Schäufele T. Transcatheter aortic valve replacement- management of patients with significant coronary artery disease undergoing aortic valve interventions: surgical compared to catheter-based approaches in hybrid procedures. BMC Cardiovasc Disord 2019; 19:108. [PMID: 31088373 PMCID: PMC6515676 DOI: 10.1186/s12872-019-1087-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/22/2019] [Indexed: 12/23/2022] Open
Abstract
Background Coronary artery disease (CAD) is associated with poorer outcomes after aortic valve replacement (AVR). For high-risk patients with complex CAD, combined transcatheter aortic valve replacement (TAVR) plus off-pump/minimally-invasive coronary artery bypass (OPCAB/MIDCAB) has been proposed. Methods A prospective registry analysis was performed to compare the characteristics and outcomes of patients undergoing TAVR+OP/MIDCAB with those undergoing TAVR plus percutaneous coronary intervention (PCI) and surgical AVR plus coronary artery bypass grafting (CABG) between 2008 and 2015 at a single site in Germany. Results 464 patients underwent SAVR+CABG, 50 underwent TAVR+OP/MIDCAB, and 112 underwent TAVR+PCI. The mean ages (p < 0.001) and logistic EuroSCOREs (p < 0.001) were similarly higher in TAVR+OP/MIDCAB and TAVR+PCI patients compared to SAVR+CABG patients. Prior cardiac surgery was more common in TAVR+PCI than in TAVR+OP/MIDCAB and SAVR+CABG patients (p < 0.001). Procedural times were shortest (p < 0.001), creatine kinase (muscle brain) levels least elevated (p < 0.001), pericardial tamponade least common (p = 0.027), and length of hospital stay shortest (p = 0.011) in TAVR+PCI, followed by TAVR+OP/MIDCAB and SAVR+CABG patients. In-hospital mortality was highest for TAVR+OP/MIDCAB patients (18.0%) with comparable rates for TAVR+PCI and SAVR+CABG groups (9.0 and 6.9%; p = 0.009). Mortality by 12 months was more probable after TAVR+OP/MIDCAB (HR: 2.17, p = 0.002) and TAVR/PCI (HR: 1.63, p = 0.010) than after SAVR+CABG, with the same true of rehospitalisation (HR: 2.39, p = 0.003 and HR: 1.63, p = 0.033). Conclusions TAVR+OP/MIDCAB patients share many characteristics with TAVR+PCI patients, with only slightly poorer long-term outcomes. In patients ineligible for SAVR+CABG and TAVR+PCI, hybrid interventions are reasonable second-line options. Electronic supplementary material The online version of this article (10.1186/s12872-019-1087-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hardy Baumbach
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
| | - Eva R Schairer
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Kristina Wachter
- Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany
| | - Christian Rustenbach
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.,Cardiothoracic Surgery, Heartcenter University Hospital Cologne, Cologne, Germany
| | - Samir Ahad
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Alina Stan
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Stephan Hill
- Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Ulrich F W Franke
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Tim Schäufele
- Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany
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23
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Abstract
See Article by Akodad et al
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Affiliation(s)
- Konstantinos Charitakis
- 1 Division of Cardiology Department of Internal Medicine University of Texas Health Science Center, Houston McGovern Medical School Houston TX
| | - Tom C Nguyen
- 2 Department of Cardiothoracic and Vascular Surgery University of Texas Health Science Center, Houston McGovern Medical School Houston TX
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24
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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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25
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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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26
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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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27
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Vranckx P, Windecker S, Welsh RC, Valgimigli M, Mehran R, Dangas G. Thrombo-embolic prevention after transcatheter aortic valve implantation. Eur Heart J 2018; 38:3341-3350. [PMID: 29020333 DOI: 10.1093/eurheartj/ehx390] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/21/2017] [Indexed: 12/16/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as a valuable treatment alternative to surgical aortic valve replacement among patients with symptomatic aortic stenosis at increased surgical risk. The rapid technological evolution from early to current-generation TAVI systems with low-profile delivery catheters, bioprosthetic valves with proven midterm durability, and improved positioning and retrieval features have made important contributions to the widespread clinical use of this minimal invasive therapy. Although peri-procedural and long-term thrombotic and bleeding events after TAVI remain a relevant concern, the optimal antithrombotic strategy and duration to mitigate these risks remain unclear. This review provides an overview of recent insights in this field, and highlights current and future antithrombotic trials focusing on optimizing outcomes in patients undergoing TAVI.
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Affiliation(s)
- Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium and Faculty of Medicine and Life Sciences Hasselt University
| | - Stephan Windecker
- Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse 8, CH-3010 Bern, Switzerland
| | - Robert C Welsh
- Mazankowski Alberta Heart Institute, University of Alberta, 11220?83 Ave NW, Edmonton, AB T6G 2B7, Canada
| | - Marco Valgimigli
- Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse 8, CH-3010 Bern, Switzerland
| | - Roxana Mehran
- Mazankowski Alberta Heart Institute, University of Alberta, 11220?83 Ave NW, Edmonton, AB T6G 2B7, Canada
| | - George Dangas
- Mazankowski Alberta Heart Institute, University of Alberta, 11220?83 Ave NW, Edmonton, AB T6G 2B7, Canada
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28
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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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29
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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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30
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Koifman E, Garcia-Garcia HM, Alraies MC, Buchanan K, Hideo-Kajita A, Steinvil A, Rogers T, Ben-Dor I, Pichard AD, Torguson R, Gai J, Satler LF, Waksman R. Correlates and Significance of Elevation of Cardiac Biomarkers Elevation Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:850-856. [PMID: 28688702 DOI: 10.1016/j.amjcard.2017.05.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/11/2017] [Accepted: 05/25/2017] [Indexed: 11/28/2022]
Abstract
The Valve Academic Research Consortium-2 recommends cutoff levels of cardiac troponin of >15 and of creatine kinase MB (CKMB) of >5 of the upper limit of normal (ULN) as markers of periprocedural myocardial infarction. We aimed to evaluate the correlation of these cutoffs with the survival rate in patients who underwent transcatheter aortic valve implantation (TAVI) through the femoral access. Patients who underwent TAVI were classified according to the postprocedural peak marker level of >15 and >5 ULN for troponin and CKMB, respectively. Baseline characteristics were compared, and the impact of these markers on a 1-year survival rate was assessed. Of 474 patients who underwent TAVI, 77% had a peak troponin level of >15 ULN, whereas only 8% had a CKMB level of >5 ULN. Factors associated with troponin and CKMB elevations differed except for the preserved ejection fraction, which was associated with the elevation of both markers. Patients with troponin elevations had higher rates of postprocedure conduction defects (p = 0.001), whereas patients with CKMB had higher rates of bleeding (p <0.001) and stroke (p = 0.03). A troponin elevation of >15 ULN had no impact on the 1-year survival rate (p = 0.52); however, patients with a CKMB level of >5 ULN had increased mortality (p = 0.008), which remained significant in the multivariate analysis (hazard ratio = 2.02, p = 0.035). Troponin level and CKMB had a good correlation (r = 0.7), and a troponin level of 75 ULN was linked with a CKMB level of >5 ULN. In conclusion, cardiac markers differ in their peak levels above the ULN after TAVI. Careful attention should be taken for patients who underwent TAVI with a CKMB level of >5 ULN, as this is the only biomarker independently associated with survival rate.
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Affiliation(s)
- Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - M Chadi Alraies
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Kyle Buchanan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Alex Hideo-Kajita
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Arie Steinvil
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Augusto D Pichard
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jiaxiang Gai
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
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Stundl A, Schulte R, Lucht H, Weber M, Sedaghat A, Shamekhi J, Zur B, Grube E, Mellert F, Welz A, Fimmers R, Nickenig G, Werner N, Sinning JM. Periprocedural Myocardial Injury Depends on Transcatheter Heart Valve Type But Does Not Predict Mortality in Patients After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:1550-1560. [DOI: 10.1016/j.jcin.2017.05.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/18/2017] [Accepted: 05/04/2017] [Indexed: 11/29/2022]
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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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33
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D’Onofrio A, Besola L, Rizzoli G, Bizzotto E, Manzan E, Tessari C, Bianco R, Tarantini G, Badano LP, Napodano M, Fraccaro C, Pittarello D, Gerosa G. Impact of Changes in Left Ventricular Ejection Fraction on Survival After Transapical Aortic Valve Implantation. Ann Thorac Surg 2017; 103:559-566. [DOI: 10.1016/j.athoracsur.2016.06.042] [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: 11/09/2015] [Revised: 05/31/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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34
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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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Conrotto F, D'Ascenzo F, D'Amico M, Moretti C, Pavani M, Scacciatella P, Omedè P, Montefusco A, Biondi-Zoccai G, Gaita F, Maisano F, Nietlispach F. Outcomes of patients with low-pressure aortic gradient undergoing transcatheter aortic valve implantation: A Meta-analysis. Catheter Cardiovasc Interv 2016; 89:1100-1106. [PMID: 27862874 DOI: 10.1002/ccd.26839] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 10/08/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND The risk/benefit balance of transcatheter aortic valve implantation (TAVI) in patients with low-gradient aortic stenosis (LGAS) remains to be well defined. Aim of the study was to investigate the impact of LGAS in patients undergoing TAVI. METHODS Medline, Cochrane Library, and Scopus were searched for articles reporting outcome of patients with LGAS undergoing TAVI. The primary endpoint was 12-months all-cause mortality and the secondary endpoint was 30-day all-cause mortality. Using event-rates as dependent variable, a meta-regression was performed to test for interaction between baseline clinical features (age, gender, diabetes mellitus, coronary artery disease, left ventricular ejection fraction (LVEF) and type of implanted valve) and transaortic gradient for the primary endpoint. RESULTS Eight studies with a total of 12,589 patients were included. Almost one-third of the patients presented with LGAS (27.3%: 24.4-29.2). Median LVEF was 48% in patients with LGAS and 56% in patients with high-gradient AS. Patients with LGAS were more likely to have diabetes mellitus, previous coronary artery disease, higher mean Logistic EuroSCORE, and lower EF. At 12 (12-16.6) months, low transaortic gradient emerged as independently associated with all-cause death, both if evaluated as a dichotomous and continuous value (respectively OR 1.17; 1.11-1.23 and OR 1.02; 1-1.04, all CI 95%). Clinical variables, including EF did not affect this result. CONCLUSIONS In a population of TAVI patients, LGAS appears to be independently related to dismal prognosis. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Claudio Moretti
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marco Pavani
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Paolo Scacciatella
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Francesco Maisano
- Heart Surgery and Cardiology, University Heart Center, Zurich, Switzerland
| | - Fabian Nietlispach
- Heart Surgery and Cardiology, University Heart Center, Zurich, Switzerland
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Sarkisian L, Saaby L, Poulsen TS, Gerke O, Hosbond S, Jangaard N, Diederichsen ACP, Thygesen K, Mickley H. Prognostic Impact of Myocardial Injury Related to Various Cardiac and Noncardiac Conditions. Am J Med 2016; 129:506-514.e1. [PMID: 26763756 DOI: 10.1016/j.amjmed.2015.12.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Elevated cardiac troponins in clinical conditions other than myocardial infarction are well known. For such occurrences, the term "myocardial injury" has been proposed. The long-term outcome in patients with myocardial injury related to various cardiac and noncardiac clinical disorders is unknown. METHODS During January 2010 to January 2011, we prospectively studied hospitalized patients who had cardiac troponin I measured on clinical indication. Patients with cardiac troponin I values >30 ng/L and no evidence of myocardial ischemia were diagnosed as having myocardial injury. Patients were classified into 5 categories of plausible related conditions: cardiac ischemic, cardiac nonischemic, noncardiac, multifactorial, or indeterminate. Follow-up was a minimum of 3 years, with all-cause mortality as the single end-point. RESULTS A total of 3762 patients were considered, of whom 1089 (29%) had myocardial injury. The most common associated conditions were noncardiac (n = 346) or multifactorial (n = 359). Cardiac ischemic (n = 183) and cardiac nonischemic (n = 134) conditions occurred less frequently. After a median of 3.2 years, 645 patients (59%) had died. A multivariate Cox regression analysis showed no difference in mortality between patients with cardiac ischemic and cardiac nonischemic conditions (hazard ratio [HR] 0.75; 95% confidence interval [CI], 0.50-1.13; P = .2). Patients with noncardiac or multifactorial disorders, however, had significantly higher mortality than those with associated cardiac ischemic conditions (HR 1.39; 95% CI, 1.06-1.80; P = .02, and HR 1.94; 95% CI, 1.50-2.51; P <.001), respectively. CONCLUSIONS In patients with myocardial injury, the most common associated conditions were noncardiac or multifactorial. Of notice, these patients had significantly higher long-term mortality when compared with those with associated cardiac conditions.
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Affiliation(s)
- Laura Sarkisian
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Tina S Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Susanne Hosbond
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Nikolaj Jangaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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Transaortic Aortic Valve Implantation in 100 Patients: Follow-up to 3 Years. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:106-11. [PMID: 27115532 DOI: 10.1097/imi.0000000000000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Transaortic aortic valve implantation (TAo-AVI) through the ascending aorta is a novel technique and is used as an alternative in patients with poor femoral access. Although early results have been promising, no midterm data have been published yet. To determine whether this approach is an acceptable treatment option, we analyzed the first 100 cases performed at our institution with a follow-up to 3 years. METHODS Between July 2011 and January 2015, a total of 100 patients with high-risk or inoperable aortic valve stenosis were treated with TAo-AVI. Preoperative patient data were collected and analyzed retrospectively. All surviving patients were seen for clinical and echocardiographic examination for follow-up. RESULTS Median follow-up was 15 months. Device success was accomplished in 94 patients (94%). There were no access site complications. The 30-day mortality rate was 9%. Stroke occurred in a total of six patients (6%). Survival at 1-, 2-, and 3 years was 75%, 62%, and 58%, respectively. CONCLUSIONS Our results show that TAo-AVI is a promising alternative to transapical implantation for treating severe inoperable aortic valve stenosis.
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38
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Ribeiro HB, Larose É, de la Paz Ricapito M, Le Ven F, Nombela-Franco L, Urena M, Allende R, Amat-Santos I, Dahou A, Capoulade R, Clavel MA, Mohammadi S, Paradis JM, De Larochellière R, Doyle D, Dumont É, Pibarot P, Rodés-Cabau J. Myocardial injury following transcatheter aortic valve implantation: insights from delayed-enhancement cardiovascular magnetic resonance. EUROINTERVENTION 2016; 11:205-13. [PMID: 26093839 DOI: 10.4244/eijv11i2a39] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to evaluate the presence, localisation and extent of myocardial injury as determined by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging in patients undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS A total of 37 patients, who underwent successful TAVI with a balloon-expandable valve (transapical [TA], n=11; non-TA, n=26), were included. Cardiac biomarker (CK-MB and cTnT) levels were determined at baseline and following TAVI. CMR was performed within a week before and within 30 days following TAVI. Some increase in cardiac biomarkers was detected in 97% of the patients as determined by a rise in cTnT, and in 49% of the patients as determined by a rise in CK-MB. Following TAVI, no new myocardial necrosis defects were observed with the non-TA approach. Nonetheless, all patients who underwent TAVI through the TA approach had new focal myocardial necrosis in the apex, with a median myocardial extent and necrotic mass of 5% [2.0-7.0] and 3.5 g [2.3-4.5], respectively. CONCLUSIONS Although some increase in cardiac biomarkers of myocardial injury was systematically detected following TAVI, new myocardial necrosis as evaluated by CMR was observed only in patients undergoing the procedure through the TA approach, involving ~5% of the myocardium in the apex.
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Affiliation(s)
- Henrique B Ribeiro
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Sinning JM, Hammerstingl C, Schueler R, Neugebauer A, Keul S, Ghanem A, Mellert F, Schiller W, Müller C, Vasa-Nicotera M, Zur B, Welz A, Grube E, Nickenig G, Werner N. The prognostic value of acute and chronic troponin elevation after transcatheter aortic valve implantation. EUROINTERVENTION 2016; 11:1522-9. [DOI: 10.4244/eijy15m02_02] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cocchieri R, Koh EY, Wollersheim LW, Meregalli PG, Bardai A, Bouma BJ, De Mol BA. Transaortic Aortic Valve Implantation in 100 Patients: Follow-up to 3 Years. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ezra Y. Koh
- Departments of Cardiothoracic Surgery, Amsterdam, the Netherlands
| | | | - Paola G. Meregalli
- Departments of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Abdenasser Bardai
- Departments of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Berto J. Bouma
- Departments of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bas A. De Mol
- Departments of Cardiothoracic Surgery, Amsterdam, the Netherlands
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42
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Kahlert P, Al-Rashid F, Plicht B, Wild C, Westhölter D, Hildebrandt H, Baars T, Neumann T, Nensa F, Nassenstein K, Wendt D, Thielmann M, Jakob H, Kottenberg E, Peters J, Erbel R, Heusch G. Myocardial injury during transfemoral transcatheter aortic valve implantation: an intracoronary Doppler and cardiac magnetic resonance imaging study. EUROINTERVENTION 2016; 11:1401-1408. [DOI: 10.4244/eijy15m05_10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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43
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Koskinas KC, Stortecky S, Franzone A, O'Sullivan CJ, Praz F, Zuk K, Räber L, Pilgrim T, Moschovitis A, Fiedler GM, Jüni P, Heg D, Wenaweser P, Windecker S. Post-Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2016; 5:JAHA.115.002430. [PMID: 26896474 PMCID: PMC4802442 DOI: 10.1161/jaha.115.002430] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Biomarkers of myocardial injury increase frequently during transcatheter aortic valve implantation (TAVI). The impact of postprocedural cardiac troponin (cTn) elevation on short‐term outcomes remains controversial, and the association with long‐term prognosis is unknown. Methods and Results We evaluated 577 consecutive patients with severe aortic stenosis treated with TAVI between 2007 and 2012. Myocardial injury, defined according to the Valve Academic Research Consortium (VARC)‐2 as post‐TAVI cardiac troponin T (cTnT) >15× the upper limit of normal, occurred in 338 patients (58.1%). In multivariate analyses, myocardial injury was associated with higher risk of all‐cause mortality at 30 days (adjusted hazard ratio [HR], 8.77; 95% CI, 2.07–37.12; P=0.003) and remained a significant predictor at 2 years (adjusted HR, 1.98; 95% CI, 1.36–2.88; P<0.001). Higher cTnT cutoffs did not add incremental predictive value compared with the VARC‐2–defined cutoff. Whereas myocardial injury occurred more frequently in patients with versus without coronary artery disease (CAD), the relative impact of cTnT elevation on 2‐year mortality did not differ between patients without CAD (adjusted HR, 2.59; 95% CI, 1.27–5.26; P=0.009) and those with CAD (adjusted HR, 1.71; 95% CI, 1.10–2.65; P=0.018; P for interaction=0.24). Mortality rates at 2 years were lowest in patients without CAD and no myocardial injury (11.6%) and highest in patients with complex CAD (SYNTAX score >22) and myocardial injury (41.1%). Conclusions VARC‐2–defined cTnT elevation emerged as a strong, independent predictor of 30‐day mortality and remained a modest, but significant, predictor throughout 2 years post‐TAVI. The prognostic value of cTnT elevation was modified by the presence and complexity of underlying CAD with highest mortality risk observed in patients combining SYNTAX score >22 and evidence of myocardial injury.
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Affiliation(s)
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Anna Franzone
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Katazyrna Zuk
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Aris Moschovitis
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Georg M Fiedler
- Center for Laboratory Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Peter Jüni
- Institute of Primary Health Care, University of Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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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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Fearon WF, Yeung AC. Clinical relevance of myocardial injury after transcatheter aortic valve replacement. J Am Coll Cardiol 2015; 66:2089-2091. [PMID: 26541918 DOI: 10.1016/j.jacc.2015.09.003] [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] [Received: 08/25/2015] [Accepted: 09/04/2015] [Indexed: 11/16/2022]
Affiliation(s)
- William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California.
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California
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Ribeiro HB, Nombela-Franco L, Muñoz-García AJ, Lemos PA, Amat-Santos I, Serra V, de Brito FS, Abizaid A, Sarmento-Leite R, Puri R, Cheema AN, Ruel M, Nietlispach F, Maisano F, Moris C, del Valle R, Urena M, Abdul Jawad Altisent O, del Trigo M, Campelo-Parada F, Jimenez Quevedo P, Alonso-Briales JH, Gutiérrez H, García del Blanco B, Perin MA, Siqueira D, Bernardi G, Dumont É, Côté M, Pibarot P, Rodés-Cabau J. Predictors and Impact of Myocardial Injury After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2015; 66:2075-2088. [DOI: 10.1016/j.jacc.2015.08.881] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/21/2015] [Accepted: 08/28/2015] [Indexed: 10/22/2022]
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Paradis JM, Maniar HS, Lasala JM, Kodali S, Williams M, Lindman BR, Damiano RJ, Moon MR, Makkar RR, Thourani VH, Babaliaros V, Xu K, Ayele GM, Svensson L, Leon MB, Zajarias A. Clinical and Functional Outcomes Associated With Myocardial Injury After Transfemoral and Transapical Transcatheter Aortic Valve Replacement: A Subanalysis From the PARTNER Trial (Placement of Aortic Transcatheter Valves). JACC Cardiovasc Interv 2015; 8:1468-1479. [PMID: 26404200 PMCID: PMC4624400 DOI: 10.1016/j.jcin.2015.06.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/05/2015] [Accepted: 06/04/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to clarify the clinical and echocardiographic prognostic implication of myocardial injury after transcatheter aortic valve replacement (TAVR). BACKGROUND The clinical significance of cardiac biomarker elevation after TAVR remains unclear. METHODS Patients treated with TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) trial were divided into tertiles (T1, T2, T3) based on the difference between the values on post-procedure day 1 and the baseline values of 2 cardiac biomarkers: cardiac troponin I (ΔcTnI); and creatine kinase-myocardial band (ΔCK-MB) fraction. Patients were stratified according to their access route: transfemoral (TF) (n = 1,840) or transapical (TA) (n = 1,173). RESULTS At 30 days after TF-TAVR, patients in the highest tertile (T3) of cardiac biomarker elevation had a higher rate of all-cause mortality (ΔcTnI: T3: 5.4% vs. T1: 0.5%, p = 0.006; ΔCK-MB: T3: 5.7% vs. T1: 0.9%, p = 0.006) and cardiovascular mortality (ΔcTnI: T3: 4.9% vs. T1: 0.5%, p = 0.01; ΔCK-MB: T3: 3.9% vs. T1: 0.5%, p = 0.02). At 1 year, only patients in the highest CK-MB tertile had higher rates of all-cause (25.4% vs. 16.8%, p = 0.02) and cardiovascular (10.3% vs. 5.0%) mortality. Multivariable analysis demonstrated that greater release of cardiac biomarkers was independently associated with increased mortality in the TF population. After TA-TAVR, being in the highest tertile of cardiac biomarker elevation had no influence on clinical and echocardiographic outcomes at 30 days and 1 year. CONCLUSIONS After TF-TAVR, a greater degree of myocardial injury was associated with higher rates of 30-day all-cause and cardiovascular mortality. At 1 year, being in the highest tertile of ΔCK-MB was correlated with a higher rate of all-cause and cardiac mortality. Finally, the level of myocardial injury after TA-TAVR had no impact on clinical and echocardiographic outcomes.
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Affiliation(s)
- Jean-Michel Paradis
- Quebec Heart and Lung Institute, Quebec, Canada; Cardiovascular Research Foundation, New York, New York.
| | - Hersh S Maniar
- Washington University School of Medicine, St Louis, Missouri
| | - John M Lasala
- Washington University School of Medicine, St Louis, Missouri
| | - Susheel Kodali
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Mathew Williams
- New York University Langone Medical Center, New York, New York
| | - Brian R Lindman
- Washington University School of Medicine, St Louis, Missouri
| | - Ralph J Damiano
- Washington University School of Medicine, St Louis, Missouri
| | - Marc R Moon
- Washington University School of Medicine, St Louis, Missouri
| | - Raj R Makkar
- Cedars Sinai Heart Institute, Los Angeles, California
| | | | | | - Ke Xu
- Cardiovascular Research Foundation, New York, New York
| | | | | | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Alan Zajarias
- Washington University School of Medicine, St Louis, Missouri
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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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49
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Lindsay AC, Mohiaddin RH. The emerging roles of cardiovascular magnetic resonance imaging in transcatheter aortic valve implantation (TAVI). EUROINTERVENTION 2015; 11:137-9. [PMID: 26093836 DOI: 10.4244/eijv11i2a26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alistair C Lindsay
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
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50
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Myocardial Injury After Transaortic Versus Transapical Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2015; 99:2001-9. [DOI: 10.1016/j.athoracsur.2015.01.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/21/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
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