Prochownik Paweł, Bielecka Klaudia, Przewłocki Tadeusz, Sachajko Zuzanna, Gancarczyk Urszula, Wilkołek Piotr, Tworek Michał, Podolec Piotr, Bielecka Larysa, Komar Monika
Department of Cardiac and Vascular Diseases, John Paul II Hospital, Institute of Cardiology, Krakow, Poland.
Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2024 Sep;20(3):338-344. doi: 10.5114/aic.2024.142326. Epub 2024 Aug 14.
Atrial septal defects (ASD) are prevalent congenital heart anomalies found in the adult population. Percutaneous ASD closure has become a routine clinical practice. Elevation of postprocedural transient cardiac biomarkers and exacerbation of supraventricular arrhythmias have been reported in the subject literature.
To explore the relationship between cardiac troponin I (cTnI) elevation and supraventricular ectopy (SVE) following percutaneous closure of secundum atrial septal defect (ASD) in adult patients.
600 consecutive patients who underwent successful transcatheter ASD secundum closure were analyzed. Serum levels of cTnI were measured before and within 72 h of device implantation. 24-hour Holter monitoring was performed before the procedure, at 1 month, and at 6 months of follow-up.
SVE burden increased 1 month after the procedure (median 1021.00; min.-max. 11.00-29 862.00) compared to baseline values (median 146.00; min.-max. 0-1865.00; < 0.01). 61.7% of patients demonstrated a cTnI rise exceeding 50% of the upper reference limit within 24 h of the procedure. A statistically significant positive correlation between SVE burden 1 month after the procedure and periprocedural cTnI increase ( < 0.05, = 0.41) was observed, while cTnI levels significantly correlated with procedure and fluoroscopy time ( < 0.001), device size ( < 0.001) and maximal ASD diameter ( < 0.001).
A significant increase of cTnI is noted frequently after transcatheter ASD closure and seems to predict exacerbation in SVE burden on short-term follow up. The independent risk factors of cTnI rise are prolonged procedure duration and larger device sizes.
房间隔缺损（ASD）是成人中常见的先天性心脏异常。经皮房间隔缺损封堵术已成为常规临床操作。相关文献报道了术后短暂性心脏生物标志物升高及室上性心律失常加重的情况。
探讨成年患者经皮继发孔房间隔缺损（ASD）封堵术后心肌肌钙蛋白I（cTnI）升高与室上性早搏（SVE）之间的关系。
对600例连续成功接受经导管继发孔ASD封堵术的患者进行分析。在装置植入前及植入后72小时内测定血清cTnI水平。在术前、术后1个月和6个月随访时进行24小时动态心电图监测。
与基线值（中位数146.00；最小值 - 最大值0 - 1865.00；P < 0.01）相比，术后1个月SVE负荷增加（中位数1021.00；最小值 - 最大值11.00 - 29862.00）。61.7%的患者在术后24小时内cTnI升高超过参考上限的50%。观察到术后1个月SVE负荷与围手术期cTnI升高之间存在统计学显著正相关（P < 0.05，r = 0.41），而cTnI水平与手术及透视时间（P < 0.001）、装置大小（P < 0.001）和最大ASD直径（P < 0.001）显著相关。
经导管ASD封堵术后经常出现cTnI显著升高，且似乎可预测短期随访中SVE负荷加重。cTnI升高的独立危险因素是手术时间延长和装置尺寸较大。
