Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
Am J Cardiol. 2013 May 1;111(9):1337-43. doi: 10.1016/j.amjcard.2012.12.059. Epub 2013 Feb 12.
The incidence and prognostic implication of myocardial injury after transcatheter aortic valve replacement (TAVR) have not been consistently studied. We aimed to assess the incidence and extent of myocardial injury after TAVR performed using transfemoral and transapical approaches. The clinical data from patients with aortic stenosis who underwent TAVR were retrospectively analyzed. The myocardial necrosis markers cardiac troponin I and creatine kinase (CK)-MB were assessed during hospitalization. Of the 150 TAVR patients, 95% and 50% had an abnormally elevated cardiac troponin I and CK-MB level, respectively. The transapical patients had significantly greater elevations of both cardiac troponin I (13.8 ± 14.0 vs 2.5 ± 5.8 ng/ml, p <0.001) and CK-MB (28.4 ± 24.2 vs 7.4 ± 8.6 ng/ml, p ≤0.001). On receiver operating curve analysis, postprocedural CK-MB (twofold increase) had high predictive power for 30-day mortality (area under the curve 0.85, p <0.001). Patients with high CK-MB levels had greater rates of postprocedural kidney injury (22% vs 6%, p = 0.026), in-hospital (22% vs 0%, p <0.001), 30-day (27% vs 1.5%, p <0.001), and 1-year mortality (41% vs 18%, p = 0.01). Baseline renal failure and no β-blocker treatment on admission were independent predictors of an elevated postprocedural CK-MB level. In conclusion, a cardiac biomarker increase after TAVR was common and more frequent among transapical access patients. A twofold increase (>7 ng/ml) in CK-MB after transfemoral TAVR was a surrogate for poor long-term outcomes.
经导管主动脉瓣置换术（TAVR）后心肌损伤的发生率和预后意义尚未得到一致研究。我们旨在评估经股动脉和经心尖途径行 TAVR 后心肌损伤的发生率和程度。回顾性分析了接受 TAVR 的主动脉瓣狭窄患者的临床数据。住院期间评估心肌坏死标志物肌钙蛋白 I 和肌酸激酶同工酶（CK-MB）。在 150 例 TAVR 患者中，分别有 95%和 50%的患者出现肌钙蛋白 I 和 CK-MB 水平异常升高。经心尖途径的患者肌钙蛋白 I（13.8±14.0 比 2.5±5.8ng/ml，p<0.001）和 CK-MB（28.4±24.2 比 7.4±8.6ng/ml，p≤0.001）升高更为显著。在受试者工作特征曲线分析中，术后 CK-MB（两倍增加）对 30 天死亡率具有较高的预测能力（曲线下面积 0.85，p<0.001）。高 CK-MB 水平的患者术后肾损伤发生率较高（22%比 6%，p=0.026），住院期间（22%比 0%，p<0.001）、30 天（27%比 1.5%，p<0.001）和 1 年死亡率（41%比 18%，p=0.01）也较高。基线肾衰竭和入院时无β受体阻滞剂治疗是术后 CK-MB 水平升高的独立预测因素。总之，TAVR 后心脏生物标志物增加较为常见，经心尖途径的患者更为频繁。经股动脉 TAVR 后 CK-MB 增加两倍（>7ng/ml）是预后不良的替代指标。
