Department of Medicine II, Heart Center Bonn, Bonn, Germany.
Institute of Clinical Chemistry and Clinical Pharmacology, Bonn, Germany.
JACC Cardiovasc Interv. 2017 Aug 14;10(15):1550-1560. doi: 10.1016/j.jcin.2017.05.029.
The aims of this study were to determine plasma elevations of biomarkers of myocardial injury associated with transfemoral (TF) transcatheter aortic valve replacement (TAVR) and to evaluate their prognostic value.
Increases in biomarkers of myocardial injury are a common finding after TAVR, but their clinical significance is unclear.
In 756 consecutive TF TAVR patients, cardiac high-sensitivity troponin I (hsTnI) and creatine kinase MB (CK-MB) levels were measured at pre-defined time points to assess the occurrence of myocardial injury (defined as 15 times the upper reference limit for hsTnI [≥1.5 ng/ml] or 5 times the upper reference limit for CK-MB [≥18 μg/l]) during the first 72 h. The primary endpoint was all-cause mortality at 1 year.
After uneventful TF TAVR, hsTnI was elevated in 51.6% and CK-MB in 7.4% of patients, respectively. Myocardial injury was associated with transcatheter heart valve (THV) type: patients who received the LOTUS THV more frequently had myocardial injury compared with those who received other THVs (LOTUS, 81.6%; Direct Flow Medical, 56.4%; CoreValve, 51.2%; Evolut R, 42.7%; SAPIEN XT, 40.4%; SAPIEN 3, 36.6%; p < 0.001). Myocardial injury defined by hsTnI was not associated with adverse outcomes at 30 days (3.1% vs. 2.7%; p = 0.778) or 1 year (16.7% vs. 17.2%; p = 0.841). Likewise, a CK-MB increase was not associated with 30-day mortality (5.5% vs. 2.8%; p = 0.258) or 1-year mortality (16.4% vs. 17.3%; p = 0.856).
Myocardial injury is common following TF TAVR. The extent of cardiac biomarker elevation depends on THV type but is not associated with adverse short- and long-term outcomes after uneventful TAVR.
本研究旨在确定与经股（TF）经导管主动脉瓣置换术（TAVR）相关的心肌损伤生物标志物的血浆升高，并评估其预后价值。
在 TAVR 后，心肌损伤生物标志物的增加是常见的，但它们的临床意义尚不清楚。
在 756 例连续的 TF TAVR 患者中，在预先确定的时间点测量心脏高敏肌钙蛋白 I（hsTnI）和肌酸激酶 MB（CK-MB）水平，以评估在最初 72 小时内是否发生心肌损伤（定义为 hsTnI 超过 15 倍参考上限[≥1.5ng/ml]或 CK-MB 超过 5 倍参考上限[≥18μg/l]）。主要终点是 1 年时的全因死亡率。
TF TAVR 后，hsTnI 在 51.6%的患者中升高，CK-MB 在 7.4%的患者中升高。心肌损伤与经导管心脏瓣膜（THV）类型有关：接受 LOTUS THV 的患者比接受其他 THV 的患者更常发生心肌损伤（LOTUS，81.6%；Direct Flow Medical，56.4%；CoreValve，51.2%；Evolut R，42.7%；SAPIEN XT，40.4%；SAPIEN 3，36.6%；p<0.001）。hsTnI 定义的心肌损伤与 30 天（3.1%比 2.7%；p=0.778）或 1 年（16.7%比 17.2%；p=0.841）时的不良结局无关。同样，CK-MB 升高与 30 天死亡率（5.5%比 2.8%；p=0.258）或 1 年死亡率（16.4%比 17.3%；p=0.856）无关。
TF TAVR 后心肌损伤很常见。心脏生物标志物升高的程度取决于 THV 类型，但与 TAVR 后无事件发生的短期和长期不良结局无关。
