The Determinants and Outcomes of Myocardial Injury After Transcatheter Aortic-Valve Implantation: SAPIEN 3 Study

被引:7
作者
Sato, Takao [1 ]
Aizawa, Yoshifusa [1 ]
Yuasa, Sho [1 ]
Taya, Yuji [1 ]
Fujita, Satoshi [1 ]
Ikeda, Yoshio [1 ]
Kitazawa, Hitoshi [1 ]
Takahashi, Minoru [1 ]
Okabe, Masaaki [1 ]
机构
[1] Tachikawa Gen Hosp, Cardiol, 1-24 Asahioka, Nagaoka, Niigata, Japan
关键词
Transcatheter aortic valve implantation; Myocardial injury; Rapid pacing; END-POINT DEFINITIONS; CLINICAL-OUTCOMES; PROGNOSTIC VALUE; TROPONIN-T; HIGH-RISK; REPLACEMENT; TAVI; VALVULOPLASTY; ASSOCIATION; MORTALITY;
D O I
10.1016/j.carrev.2019.12.028
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The effect of myocardial injury (MI) post-transcatheter aortic valve implantation (TAVI) on clinical outcomes is controversial. This study aimed to evaluate the effect of MI severity on clinical outcome and left ventricle function 30 days post-TAVI and determine MI post-TAVI predictors. Methods: Overall, 138 consecutive patientswho underwent successful transfemoral TAVI using SAPIEN3 and diagnosed using echocardiography and computed tomography were analyzed. High-sensitivity cardiac troponin T (TnT) was evaluated at baseline, immediately, and at 24, 48, and 72 h post-TAVI. Echocardiography findings and N-terminal pro-B-type natriuretic peptide ( Nt-pro BNP) levels were evaluated 30 days postTAVI. Results: Mean age and STS score were 84.4 +/- 3.5 years and 6.4 +/- 3.2%, respectively. All cases showed severe aortic valve stenosis. Peri-procedural MI was observed in 48 of 100 patients (48.0%). Patients were grouped into MI (n = 48) and non-MI (n = 52), without significant difference in characteristics. Pre-balloon aortic valvuloplasty rate and total pacing time were significantly higher in MI vs non-MI. Total rapid pacing time (TRPT) was an independent predictor for MI (OR 1.06; 95% CI 1.01-1.16; p = 0.04). Echocardiography and Nt-pro BNP changes 30 days post-TAVI were similar between groups. Conclusion: Peri-procedural MI, assessed by TnT changes, was observed in 48% of patients. The MI was not associated with overt cardiac dysfunction, and the recovery of left ventricular function and Nt-pro BNP level occurred similarly by 30 day post-TAVI between both groups. In multivariate analysis, TRPT was associated with MI after SAPIEN3 implantation. Trial registration number: UMIN000036669. (c) 2019 Elsevier Inc. All rights reserved.
引用
收藏
页码:973 / 979
页数:7
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