Author + information
- Received December 27, 2016
- Revision received April 18, 2017
- Accepted May 4, 2017
- Published online August 7, 2017.
- Anja Stundl, MDa,
- Regina Schulte, MDa,
- Hannah Lucht, MDa,
- Marcel Weber, MDa,
- Alexander Sedaghat, MDa,
- Jasmin Shamekhi, MDa,
- Berndt Zur, MDb,
- Eberhard Grube, MDa,
- Fritz Mellert, MDc,
- Armin Welz, MDc,
- Rolf Fimmers, MDd,
- Georg Nickenig, MDa,
- Nikos Werner, MDa and
- Jan-Malte Sinning, MDa,∗ ()
- aDepartment of Medicine II, Heart Center Bonn, Bonn, Germany
- bInstitute of Clinical Chemistry and Clinical Pharmacology, Bonn, Germany
- cDepartment of Cardiothoracic Surgery, Heart Center Bonn, Bonn, Germany
- dInstitute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
- ↵∗Address for correspondence:
Dr. Jan-Malte Sinning, Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
Objectives The aims of this study were to determine plasma elevations of biomarkers of myocardial injury associated with transfemoral (TF) transcatheter aortic valve replacement (TAVR) and to evaluate their prognostic value.
Background Increases in biomarkers of myocardial injury are a common finding after TAVR, but their clinical significance is unclear.
Methods In 756 consecutive TF TAVR patients, cardiac high-sensitivity troponin I (hsTnI) and creatine kinase MB (CK-MB) levels were measured at pre-defined time points to assess the occurrence of myocardial injury (defined as 15 times the upper reference limit for hsTnI [≥1.5 ng/ml] or 5 times the upper reference limit for CK-MB [≥18 μg/l]) during the first 72 h. The primary endpoint was all-cause mortality at 1 year.
Results After uneventful TF TAVR, hsTnI was elevated in 51.6% and CK-MB in 7.4% of patients, respectively. Myocardial injury was associated with transcatheter heart valve (THV) type: patients who received the LOTUS THV more frequently had myocardial injury compared with those who received other THVs (LOTUS, 81.6%; Direct Flow Medical, 56.4%; CoreValve, 51.2%; Evolut R, 42.7%; SAPIEN XT, 40.4%; SAPIEN 3, 36.6%; p < 0.001). Myocardial injury defined by hsTnI was not associated with adverse outcomes at 30 days (3.1% vs. 2.7%; p = 0.778) or 1 year (16.7% vs. 17.2%; p = 0.841). Likewise, a CK-MB increase was not associated with 30-day mortality (5.5% vs. 2.8%; p = 0.258) or 1-year mortality (16.4% vs. 17.3%; p = 0.856).
Conclusions Myocardial injury is common following TF TAVR. The extent of cardiac biomarker elevation depends on THV type but is not associated with adverse short- and long-term outcomes after uneventful TAVR.
Drs. Sinning, Grube, Nickenig, and Werner have received research grants and speaking honoraria from Medtronic, Edwards Lifesciences, and Boston Scientific. Dr. Grube works as proctor for Medtronic and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 27, 2016.
- Revision received April 18, 2017.
- Accepted May 4, 2017.
- 2017 American College of Cardiology Foundation