Cardiac Troponin Levels after Percutaneous Atrial Septal Defect Closure: A Qualitative Systematic Review and Meta-Analysis

Introduction: We conducted a systematic review and meta-analysis of published studies to determine the prevalence of troponin elevation after percutaneous atrial septal defect closure (pASDc) as well as to describe the association between troponin elevation and different anatomical risk factors for erosion. Methods: A qualitative systematic review and meta-analysis was undertaken. The selected studies included patients of any age receiving a pASDc; performed under transesophageal echocardiography monitoring; reporting troponin level measurement after the intervention; and indicating prevalence of troponin elevation and/or the association with risk factors for erosion. Results: Six studies were found which included 391 patients in total. The age of the patients ranged from 1 to 80 years and were mainly female (between 59 and 81%). The success rate of pASDc varied from 92-100%. The prevalence of myocardial injury varied between 16% and 100%. In the meta-analysis cohort including 347 patients with available data, the fixed effect model showed a prevalence of 41.8% CI (95%) 36.6% to 47.2%. Five studies found a relationship between the size of the implanted device and the presence of myocardial injury. The size of the defect, multiple defects within the interatrial septum, deficient posterior rim, lack of use of sizing balloon and longest duration of the procedure were also related to myocardial injury. Conclusion: The usefulness of troponin levels measurements after pASDc has been insufficiently studied. The routinely use in a standardized protocol would be useful to determine which patients need a closer follow-up.