Predictors and Impact of Myocardial Injury After Transcatheter Aortic Valve Replacement: A Multicenter Registry

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• 作者：Henrique B. Ribeiro ; MD^&lowast ; ; Luis Nombela-Franco ; MD^&dagger ; ; Antonio J. Muñ ; oz-Garcí ; a ; MD ; PhD^&Dagger ; ; Pedro Alves Lemos ; MD ; PhD^§ ; ; Ignacio Amat-Santos ; MD^‖ ; Vicen&ccedil ; Serra ; MD^¶ ; ; Fabio S. de Brito Jr. ; MD^# ; Alexandre Abizaid ; MD^&lowast ; &lowast ; ; Rogé ; rio Sarmento-Leite ; MD^&dagger ; &dagger ; ; Rishi Puri ; MBBS ; PhD^&lowast ; ; Asim N. Cheema ; MD^&Dagger ; &Dagger ; ; Marc Ruel ; MD^§ ; § ; ; Fabian Nietlispach ; MD ; PhD^‖‖ ; Francesco Maisano ; MD^‖‖ ; Cesar Moris ; MD^¶ ; ¶ ; ; Raquel del Valle ; MD^¶ ; ¶ ; ; Marina Urena ; MD^&lowast ; ; Omar Abdul Jawad Altisent ; MD^&lowast ; ; Maria del Trigo ; MD^&lowast ; ; Francisco Campelo-Parada ; MD^&lowast ; ; Pilar Jimenez Quevedo ; MD^&dagger ; ; Juan H. Alonso-Briales ; MD^&Dagger ; ; Hipó ; lito Gutié ; rrez ; MD^‖ ; Bruno Garcí ; a del Blanco ; MD^¶ ; ; Marco Antonio Perin ; MD^# ; Dimytri Siqueira ; MD^&lowast ; &lowast ; ; Guilherme Bernardi ; MD^&dagger ; &dagger ; ; É ; ric Dumont ; MD^&lowast ; ; Melanie Cô ; té ; MSc^&lowast ; ; Philippe Pibarot ; DVM ; PhD^&lowast ; ; Josep Rodé ; s-Cabau ; MD^&lowast ; ; ^{josep.rodes@criucpq.ulaval.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：aortic stenosis ; cardiac biomarkers ; creatine kinase-MB ; transapical ; transcatheter aortic valve replacement
• 刊名：Journal of the American College of Cardiology
• 出版年：2015
• 出版时间：10 November 2015
• 年：2015
• 卷：66
• 期：19
• 页码：2075-2088
• 全文大小：1330 K

文摘

Cardiac biomarker release signifying myocardial injury post-transcatheter aortic valve replacement (TAVR) is common, yet its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown.

Objectives

This study sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation post TAVR.

Methods

This multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical (TA) approaches were selected in 73.1% and 20.3% of patients, respectively. Creatine kinase-myocardial band (CK-MB) measurements were obtained at baseline and at several time points within the initial 72 h post TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up.

Results

Overall, 66% of the TAVR population demonstrated some degree of myocardial injury as determined by a rise in CK-MB levels (peak value: 1.6-fold [interquartile range (IQR): 0.9 to 2.8-fold]). A TA approach and major procedural complications were independently associated with higher peak of CK-MB levels (p < 0.01 for all), which translated into impaired systolic left ventricular function at 6 to 12 months post TAVR (p < 0.01). A greater rise in CK-MB levels independently associated with an increased 30-day, late (median of 21 [IQR: 8 to 36] months) overall and cardiovascular mortality (p < 0.001 for all). Any increase in CK-MB levels was associated with poorer clinical outcomes, and there was a stepwise rise in late mortality according to the various degrees of CK-MB increase after TAVR (p < 0.001).

Conclusions

Some degree of myocardial injury was detected in two-thirds of patients post TAVR, especially in those undergoing TA-TAVR or presenting with major procedural complications. A greater rise in CK-MB levels associated with greater acute and late mortality, imparting a negative impact on left ventricular function.