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Predictors and impact of myocardial injury after transcatheter aortic valve replacement : a multicenter registry.

Predictors and impact of myocardial injury after transcatheter aortic valve replacement : a multicenter registry.

Authors :
Campelo-Parada, Francisco
Dumont, Éric
Muñoz, Antonio
Abdul-Jawad Altisent, Omar
Lemos, Pedro A.
Côté, Mélanie
Nombela-Franco, Luis
Serra, Vicenç
Rodés-Cabau, Josep
Brito, Fabio Sandoli de
Amat Santos, Ignacio J.
Abizaid, Alexandre
Del Trigo, Maria
Sarmento-Leite, Rogério
Urena Alcazar, Marina
Pibarot, Philippe
Cheema, Asim
Puri, Rishi
Ruel, Marc
Ribeiro, Henrique B.
Nietlispach, Fabian
Maisano, Francesco
Moris, Cesar
Valle, Raquel del
Jiménez-Quevedo, Pilar
Alonso-Briales, Juan H.
Gutiérrez, Hipólito
García del Blanco, Bruno
Perin, Marco Antonio
Siqueira, Dimytri
Bernardi, Guilherme
Campelo-Parada, Francisco
Dumont, Éric
Muñoz, Antonio
Abdul-Jawad Altisent, Omar
Lemos, Pedro A.
Côté, Mélanie
Nombela-Franco, Luis
Serra, Vicenç
Rodés-Cabau, Josep
Brito, Fabio Sandoli de
Amat Santos, Ignacio J.
Abizaid, Alexandre
Del Trigo, Maria
Sarmento-Leite, Rogério
Urena Alcazar, Marina
Pibarot, Philippe
Cheema, Asim
Puri, Rishi
Ruel, Marc
Ribeiro, Henrique B.
Nietlispach, Fabian
Maisano, Francesco
Moris, Cesar
Valle, Raquel del
Jiménez-Quevedo, Pilar
Alonso-Briales, Juan H.
Gutiérrez, Hipólito
García del Blanco, Bruno
Perin, Marco Antonio
Siqueira, Dimytri
Bernardi, Guilherme
Publication Year :
2016

Abstract

BACKGROUND : 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 ventricula

Details

Database :
OAIster
Notes :
application/pdf, English
Publication Type :
Electronic Resource
Accession number :
edsoai.on1369987192
Document Type :
Electronic Resource