Incidence, Predictors, and Midterm Clinical Outcomes of Myocardial Injury After Transcatheter Aortic-Valve Implantation

Abstract

Our aim was to assess the clinical effects of myocardial injury after transcatheter aortic-valve implantation (TAVI). Between October 2013 and July 2016, 157 patients underwent TAVI with Sapien XT, Sapien 3, or Cor-eValve prostheses at our institute. Of these, 130 patients for whom the transapical approach was not used were included in this study. Myocardial injury was defined as a peak troponin I level of ! 1.5 ng/mL within 48 hours after TAVI. We evaluated the predictors of myocardial injury and compared the clinical outcomes of 82 patients classified as the myocardial injury group and 44 patients classified as the non-myocardial injury group. The patients were aged 85 6 years. Myocardial injury occurred in 82 patients (65.1%). Age (per 1 increase) (odds ratio [

Impact of bioprosthetic valve type on peri-procedural myocardial injury and mortality after transcatheter aortic valve replacement

“…In agreement with previous data, we demonstrate an association between PPMI and higher LVEF, probably because viable myocardial tissue results in higher enzymes release, and also with worse baseline kidney function [8,[22][23][24], whereas we could not observe an independent association between PPMI and pre-TAVR valvuloplasty, mean procedural duration, and previous MI or CAD as reported in other cohorts [8,9,17,[22][23][24], probably due to heterogenous sampling and selection biases. PPMI has a mainly procedural origin, related to mechanical trauma to the myocardium due to contact with valve struts, potential multiple episodes of hypotension during valve release, and myocardial ischemia due to balloon valvuloplasty and/or valve implantation itself [15,17].…”

“…PPMI has a mainly procedural origin, related to mechanical trauma to the myocardium due to contact with valve struts, potential multiple episodes of hypotension during valve release, and myocardial ischemia due to balloon valvuloplasty and/or valve implantation itself [15,17]. Of note, we found that SEV implantation might be associated to a higher risk of PPMI has already been reported, but mainly as a collateral result, and without adjustment for other procedural and clinical variables [8,17,[22][23][24]. We employed a rigorous analytic approach that included multivariable and non-parsimonious propensity-weighted analysis: the important implication of our study, thus, is that, when the choice of implanting a SEV is made, a two-to threefold higher risk of PPMI should be accounted.…”

“…Myocardial infarction (MI) is a rare and potentially life-threatening complication of TAVR, usually caused by mechanical interference of prosthesis with coronary ostia, nonetheless a PPMI which is based on bio-humoral markers of myocardial injury is commonly reported and generally clinically silent [7-9, 14-16, 19, 21]. In our cohort, we observed a PPMI rate of 79.0% which is one the highest reported in the literature so far [6,15,[22][23][24]. This result is probably explained by several factors: first and foremost, we adopted the new VARC-2 definition of myocardial injury and used the troponin I as the biomarker of choice: TnI seems to be less stable and more related to peri-procedural complications and non-cardiac cause of PPMI (e.g., ischemia related to anemia or dehydration, acute kidney injury, or severe hypoxia due to acute respiratory failure) than CK-MB [19], which was used in some previous studies [7][8][9].…”

Sex-Related Differences in Cardiac Remodeling and Reverse Remodeling After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis in a Japanese Population

“…It is still debated whether sex-specific factors influence and modify the clinical course of AS over time and whether hormonal changes, including history of pregnancy and age of menopause, can impact TAVI outcomes. [23][24][25] Myocardial response to pressure overload is different in women and men, 6,7,26) and it has been reported that female patients have a higher prevalence of normal geometry and concentric remodeling, while male patients show a higher rate of maladaptive remodeling (including concentric hypertrophy and eccentric hypertrophy) that eventually leads to LV dilation. 6,8) Women also typically have higher LVEF; however, little is known about the role of gender in LV remodeling in extreme age in the Japanese population.…”

Antithrombotic Therapy After Transcatheter Aortic Valve Implantation

“…A higher degree of myocardial injury has been associated with increased mortality in some studies, but other investigations failed to observe a prognostic impact in TAVI patients. [18][19][20][21] Nevertheless, it is relevant to identify coronary artery disease in TAVI candidates, since both conditions frequently coexist (30-70%) and the severity of coronary artery disease might impact prognosis after TAVI. [22][23][24] The decision about revascularisation, its completeness and timing (staged or concomitant procedures) should be made on a case-by-case basis for patients undergoing TAVI.…”