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Prognostically Significant Myocardial Injury in Patients Undergoing Transcatheter Aortic Valve Replacement
Journal article   Peer reviewed

Prognostically Significant Myocardial Injury in Patients Undergoing Transcatheter Aortic Valve Replacement

Vikram Sharma, Tanujit Dey, Kesavan Sankaramangalam, Shehab A R Alansari, Louis Williams, Stephanie Mick, Amar Krishnaswamy, Lars G Svensson and Samir Kapadia
Journal of the American Heart Association, Vol.8(14), pp.e011889-e011889
07/16/2019
DOI: 10.1161/JAHA.118.011889
PMCID: PMC6662140
PMID: 31267799

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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.
 Aged Aged, 80 and over Aortic Valve Stenosis - complications Aortic Valve Stenosis - surgery Coronary Artery Disease - complications Female Humans Male Mortality Myocardial Ischemia - blood Postoperative Complications - blood Prognosis Retrospective Studies Transcatheter Aortic Valve Replacement - methods Troponin T - blood

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