Valve Type May Predict Myocardial Injury After Transfemoral TAVR

HealthDay News — Myocardial injury occurs frequently following transfemoral (TF) transcatheter aortic valve replacement (TAVR), but does not predict outcome, according to a study published in JACC: Cardiovascular Interventions.

Anja Stundl, MD, from Heart Center Bonn in Germany, and colleagues measured cardiac high-sensitivity troponin I (hsTnI) and creatine kinase MB (CK-MB) levels at pre-defined time points in 756 consecutive TF TAVR patients to assess the occurrence of myocardial injury during the first 72 hours.

The researchers found that hsTnI and CK-MB were elevated in 51.6% and 7.4%  of patients, respectively, after uneventful TF TAVR. There was a correlation for myocardial injury with transcatheter heart valve (THV) type: Patients who received LOTUS THV more often had myocardial injury (LOTUS, 81.6%; Direct Flow Medical, 56.4%; CoreValve, 51.2%; Evolut R, 42.7%; SAPIEN XT, 40.4%; SAPIEN 3, 36.6%; P < .001). 

There was no correlation for myocardial injury defined by hsTnI with adverse outcomes at 30 days (3.1 vs 2.7%; P =.778) or 1 year (16.7% vs 17.2%; P = .841). An increase in CK-MB was also not associated with mortality at 30 days (5.5% vs 2.8%; P =.258) or 1 year (16.4% vs 17.3%; P =.856).

“The extent of cardiac biomarker elevation depends on THV type but is not associated with adverse short- and long-term outcomes after uneventful TAVR,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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Stundl A, Schulte R, Lucht H, et al. Periprocedural myocardial injury depends on transcatheter heart valve type but does nor predict mortality in patients after transcatheter aortic valve replacement. JACC: Cardiovascular Interventions. Aug 2017, 10 (15) 1550-1560.