经导管主动脉瓣置换术后肌钙蛋白 T 升高的临床意义：TAVR 后肌钙蛋白升高。
Clinical implications of troponin-T elevations following TAVR: Troponin Increase Following TAVR.
机构信息
The Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
The Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
出版信息
J Cardiol. 2022 Feb;79(2):240-246. doi: 10.1016/j.jjcc.2021.08.030. Epub 2021 Sep 15.
BACKGROUND
Baseline and post-procedural elevations in serum troponin-T levels are associated with increased morbidity and mortality following transcatheter aortic valve replacement (TAVR). However, the prognostic impact of change in serum troponin-T level following TAVR remains unknown.
METHODS
Among the patients with severe aortic stenosis who underwent TAVR, those with baseline serum troponin-T level ≥51.5 ng/L were excluded. The impact of increases in serum troponin-T level to an abnormally high range (≥51.5 ng/L) following TAVR on 2-year cardiovascular death or heart failure readmissions was investigated.
RESULTS
Among 189 included patients (median 86 years old, 28% men), serum troponin-T level increased in 79 patients following TAVR. An increase in serum troponin-T was associated with a higher rate of 30-day adverse events, predominantly due to pacemaker implantation for complete atrio-ventricular block, and a higher 2-year cumulative incidence of the primary endpoint (hazard ratio 5.24, 95% confidence interval 1.64-16.8, p = 0.005) adjusted for the potential confounders.
CONCLUSION
Post-procedural increase in serum troponin-T level was associated with adverse clinical outcomes following TAVR.
背景
经导管主动脉瓣置换术（TAVR）后，血清肌钙蛋白 T 水平的基线和术后升高与发病率和死亡率增加相关。然而，TAVR 后血清肌钙蛋白 T 水平变化的预后影响尚不清楚。
方法
在接受 TAVR 的重度主动脉瓣狭窄患者中，排除基线血清肌钙蛋白 T 水平≥51.5ng/L 的患者。研究了 TAVR 后血清肌钙蛋白 T 水平升高至异常高范围（≥51.5ng/L）对 2 年心血管死亡或心力衰竭再入院的影响。
结果
在 189 名纳入的患者中（中位年龄 86 岁，28%为男性），79 名患者在 TAVR 后血清肌钙蛋白 T 水平升高。血清肌钙蛋白 T 升高与 30 天不良事件发生率较高相关，主要是由于完全房室传导阻滞而植入起搏器，以及主要终点的 2 年累积发生率较高（风险比 5.24，95%置信区间 1.64-16.8，p=0.005），校正了潜在混杂因素。
结论
TAVR 后血清肌钙蛋白 T 水平升高与不良临床结局相关。
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