The prognostic value of acute and chronic troponin elevation after transcatheter aortic valve implantation

Abstract

Myocardial injury defined as ΔTroponin ≥15x URL after TAVI seems to be a procedure-related issue without impact on 30-day and one-year survival. However, monitoring of post-procedural troponin might be useful for prognostication after TAVI.

Preprocedural but not periprocedural high‐sensitive Troponin T levels predict outcome in patients undergoing transcatheter aortic valve implantation

“…Recently, Sinning and colleagues used cardiac troponin I (cTNI) and CK‐MB to analyze incidence and prognostic relevance of periprocedural myocardial injury. While 51.8% of all patents fulfilled the VARC‐II criteria in serial measurements of cTNI, only 9.1% of the patients met the CK‐MB‐based definition . In line with our results obtained using hsTNT, the authors could not show a significant impact of myocardial injury as defined in the VARC‐II criteria on 30‐day or one‐year survival after TAVI.…”

Post‐Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation

“…Previous studies have yielded conflicting results, with some investigations showing an impact of cardiac troponin (cTn) elevation on post-TAVI outcomes [5][6][7] and others dissociating postprocedural cTn levels from subsequent adverse events. 8,9 Previous reports were limited by smaller patient numbers and shorter duration of follow-up and did not assess prognostic implications of cTn elevation according to the presence and complexity of coronary artery disease (CAD), despite the fact that coexisting coronary atherosclerosis varies substantially among patients with AS 10 and affects the magnitude of myocardial necrosis during TAVI interventions. 8 Most notably, earlier investigations applied distinctly different cutoffs of cTn to define myocardial injury, ranging from any increase, 7,9 59 increase, 6 and up to 159 the upper limit of normal (ULN), 5,8 such that the proportion of patients with reported cTn elevation ranged from 17% to 99%.…”

“…8,9 Previous reports were limited by smaller patient numbers and shorter duration of follow-up and did not assess prognostic implications of cTn elevation according to the presence and complexity of coronary artery disease (CAD), despite the fact that coexisting coronary atherosclerosis varies substantially among patients with AS 10 and affects the magnitude of myocardial necrosis during TAVI interventions. 8 Most notably, earlier investigations applied distinctly different cutoffs of cTn to define myocardial injury, ranging from any increase, 7,9 59 increase, 6 and up to 159 the upper limit of normal (ULN), 5,8 such that the proportion of patients with reported cTn elevation ranged from 17% to 99%. Using the current Valve Academic Research Consortium (VARC)-2 cTn cutoff of 159 ULN to define myocardial injury, 11 2 studies have reported discordant results regarding the predictive merit of cTnT elevation post-TAVI.…”

Transcatheter Aortic Valve Replacement: 2015 in Review

“…In 276 patients undergoing TAVR, myocardial injury occurred in 52% during the first 72 hours following TAVR. 51 Use of a self-expanding prosthesis, CAD, higher LVEF, and procedure time were independent predictors. Thirty-day and 1-year mortality were not related to the occurrence of post-TAVR myocardial injury.…”

“…According to VARC‐2 definitions, myocardial injury is defined as troponin ≥15x upper limit of normal. In 276 patients undergoing TAVR, myocardial injury occurred in 52% during the first 72 hours following TAVR . Use of a self‐expanding prosthesis, CAD, higher LVEF, and procedure time were independent predictors.…”