Wang Xiaoyan, Chen Xueying, Ye Yong, Peng Juan, Lin Jinyi, Deng Xin, Lin Li, You Jieyun, Wang Xingxu, Zhou Daxin, Chen Qingxing, Ge Junbo
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China.
Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2021 Oct 1;8:721224. doi: 10.3389/fcvm.2021.721224. eCollection 2021.
Cardiac troponin T (cTNT) has been widely used in detecting cardiac damage. Elevated cTNT level has been reported to be associated with increased mortality in multiple cardiac conditions. It is not uncommon to observe an increased level of cTNT in patients after left atrial appendage occlusion (LAAO). The objective of the study is to study the incidence, significance, and factors associated with cTNT elevation after LAAO. We prospectively included patients who underwent LAAO from January 2019 to July 2020 in Fudan Zhongshan Hospital. Patients were divided into those with elevated cTNT after procedure and those with normal postprocedure cTNT. All individuals were followed up for 1 year. The primary outcome is major adverse cardiovascular events, which include myocardial infarction, heart failure, cardiac death, and stroke. The second outcome is periprocedure complication, including chest pain, tachycardia, cardiac tamponade, change of electrocardiograph, and atrial thrombus. A total of 190 patients were enrolled. Of the patients, 85.3% had elevated cTNT after LAAO, while 14.7% of them did not. Exposure time, dosage of contrast, types of devices, shapes, and sizes of LAA could contribute to elevated postprocedure cTNT. We found that patients with a Watchman device were more likely to have elevated postprocedure cTNT than those with a Lambre device (89.2 vs. 76.7%, = 0.029). LAAO shapes were associated with cTNT levels in patients with a Watchman device, while the diameter of the outer disc and LAA depth mattered for the Lambre device. There was no significant difference in the primary and second outcome between the two groups (-value: 0.619, 0.674). LAAO was found to be commonly accompanied with cTNT elevation, which might not to be related to the complications and adverse cardiac outcomes within 1 year of follow-up. Moreover, eGFR at baseline, exposure time, dosage of contrast, types of LAAO device, and LAA morphology could contribute to cTNT elevation.
心肌肌钙蛋白T（cTNT）已被广泛用于检测心脏损伤。据报道，cTNT水平升高与多种心脏疾病的死亡率增加有关。左心耳封堵术（LAAO）后患者中观察到cTNT水平升高并不罕见。本研究的目的是探讨LAAO后cTNT升高的发生率、意义及相关因素。我们前瞻性纳入了2019年1月至2020年7月在复旦大学附属中山医院接受LAAO的患者。患者被分为术后cTNT升高组和术后cTNT正常组。所有个体均随访1年。主要结局是主要不良心血管事件，包括心肌梗死、心力衰竭、心源性死亡和中风。次要结局是围手术期并发症，包括胸痛、心动过速、心脏压塞、心电图改变和心房血栓。共纳入190例患者。其中，85.3%的患者在LAAO后cTNT升高，而14.7%的患者未升高。暴露时间、造影剂剂量、器械类型、左心耳的形状和大小可能导致术后cTNT升高。我们发现，使用Watchman器械的患者术后cTNT升高的可能性高于使用Lambre器械的患者（89.2%对76.7%，P = 0.029）。对于使用Watchman器械的患者，左心耳封堵形状与cTNT水平相关，而对于Lambre器械，外盘直径和左心耳深度起重要作用。两组之间的主要和次要结局无显著差异（P值：0.619，0.674）。发现LAAO常伴有cTNT升高，这可能与随访1年内的并发症和不良心脏结局无关。此外，基线估算肾小球滤过率（eGFR）、暴露时间、造影剂剂量、LAAO器械类型和左心耳形态可能导致cTNT升高。
