Incidence, predictive factors, and prognostic value of myocardial injury following uncomplicated transcatheter aortic valve implantation.

Authors: Rodés-Cabau, Josep; Gutiérrez, Marcos; Bagur, Rodrigo HernanDe Larochellière, RobertDoyle, DanielCôté, MélanieVilleneuve, JacquesBertrand, OlivierLarose, ÉricManazzoni, JuanPibarot, PhilippeDumont, Éric
Abstract: OBJECTIVES: This study sought to: 1) determine the incidence, degree, and timing of the rise in serum cardiac markers of myocardial injury associated with uncomplicated transcatheter aortic valve implantation (TAVI); and 2) evaluate the predictive factors and prognostic value of myocardial injury associated with TAVI. BACKGROUND: Very few data exist on the occurrence and clinical relevance of myocardial injury during TAVI procedures. METHODS: A total of 101 patients who underwent successful TAVI (transfemoral [TF] approach, n = 38; transapical [TA] approach, n = 63) were included. Creatine kinase-MB (CK-MB) and cardiac troponin T (cTnT) levels were determined at baseline and at 6 to 12, 24, 48, and 72 h following TAVI. RESULTS: TAVI was associated with some degree of myocardial injury in 99% of the patients (TF: 97%, TA: 100%) as determined by a rise in cTnT (maximal value, 0.48 µg/l, interquartile range [IQR]: 0.24 to 0.82 µg/l) and in 77% of the patients (TF: 47%, TA: 95%) as determined by a rise in CK-MB (maximal value, 18.6 µg/l; IQR: 11.0 to 27.4 µg/l). TA approach and baseline renal dysfunction were associated with a higher increase in biomarkers of myocardial injury (p < 0.01 for both). A larger myocardial injury was associated with a smaller improvement of left ventricular ejection fraction (LVEF) (p < 0.01). The degree of rise in cTnT was an independent predictor of cardiac mortality at 9 ± 10 months of follow-up (hazard ratio: 1.14 per each increase of 0.1 µg/l, 95% confidence interval: 1.02 to 1.28, p = 0.028). CONCLUSIONS: TAVI was systematically associated with some degree of myocardial injury, with TA approach and baseline renal dysfunction determining a higher increase in biomarkers of myocardial injury. A greater degree of myocardial injury was associated with less improvement in LVEF and a higher cardiac mortality at follow-up.
Document Type: Article de recherche
Issue Date: 17 May 2011
Open Access Date: Restricted access
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/7821
This document was published in: Journal of the American College of Cardiology, Vol. 57 (20), 1988–1999 (2011)
https://doi.org/10.1016/j.jacc.2010.11.060
Elsevier Biomedical
Alternative version: 10.1016/j.jacc.2010.11.060
21565636
Collection:Articles publiés dans des revues avec comité de lecture

Files in this item:
SizeFormat 
Rodés-Cabau2011-12542.pdf
756.7 kBAdobe PDF    Request a copy
All documents in CorpusUL are protected by Copyright Act of Canada.