Background: Chronic pre-procedural and acute post-procedural myocardial injury are frequently observed in patients with aortic stenosis undergoing trans-catheter aortic valve implantation (TAVI). The aim of our study was to investigate the prognostic role of high sensitivity cardiac troponins (hs-cTns) elevation before and after TAVI. Methods: 106 patients with severe aortic stenosis who underwent TAVI were enrolled. High sensitivity cardiac troponin T (hs-cTnT) was measured before and after TAVI (6, 24, 48, 72 hours). Post-procedural myocardial damage was defined as a 15-fold rise in hs-cTnT upper reference limit (URL) after TAVI. The clinical endpoints were all cause death, cardiovascular death and rehospitalization at 24 months follow-up. Results: Before TAVI, hs-cTnT median value was 0.03 μg/L (2.3 ± 2.1 fold over URL). After TAVI procedure, myocardial damage (MD), as defined by VARC-2 criteria, was observed in 40 patients (38%) (MD group). In our population, logarithmically transformed hs-cTnTs were independently associated with all-cause mortality at 24 months F/U (pre-TAVI hs-cTnT: Hazard ratio [HR] 2.2, 95% confidence interval [CI]: 1.1 to 4.4, p=0.027). No significant differences were observed between the MD and non-MD groups for the three endpoints of all cause death (p log rank: 0.15), cardiovascular death (p log rank: 0.86) and re-hospitalization (p log rank: 0.87). Conclusions: Only baseline hs-cTnT levels correlated with outcomes at 24 months of follow-up. Chronic pre-procedural myocardial injury significantly affects prognosis after TAVI

Prognostic role of pre- and post-interventional myocardial injury in patients undergoing transcatheter aortic valve implantation / Filomena, D; Monosilio, S; Cimino, S; Maestrini, V; Luongo, F; Neccia, M; Salvi, N; Colantonio, R; Mancone, M; Sardella, G; Fedele, F; Agati, L. - In: MINERVA CARDIOLOGY AND ANGIOLOGY. - ISSN 2724-5683. - (2021). [10.23736/S2724-5683.21.05630-1]

Prognostic role of pre- and post-interventional myocardial injury in patients undergoing transcatheter aortic valve implantation

Filomena D
Writing – Original Draft Preparation
;
Monosilio S
Formal Analysis
;
Cimino S
Conceptualization
;
Maestrini V
Membro del Collaboration Group
;
Luongo F
Membro del Collaboration Group
;
Neccia M;Salvi N;Colantonio R;Mancone M
Supervision
;
Sardella G
Investigation
;
Fedele F
Penultimo
Visualization
;
Agati L
Ultimo
Supervision
2021

Abstract

Background: Chronic pre-procedural and acute post-procedural myocardial injury are frequently observed in patients with aortic stenosis undergoing trans-catheter aortic valve implantation (TAVI). The aim of our study was to investigate the prognostic role of high sensitivity cardiac troponins (hs-cTns) elevation before and after TAVI. Methods: 106 patients with severe aortic stenosis who underwent TAVI were enrolled. High sensitivity cardiac troponin T (hs-cTnT) was measured before and after TAVI (6, 24, 48, 72 hours). Post-procedural myocardial damage was defined as a 15-fold rise in hs-cTnT upper reference limit (URL) after TAVI. The clinical endpoints were all cause death, cardiovascular death and rehospitalization at 24 months follow-up. Results: Before TAVI, hs-cTnT median value was 0.03 μg/L (2.3 ± 2.1 fold over URL). After TAVI procedure, myocardial damage (MD), as defined by VARC-2 criteria, was observed in 40 patients (38%) (MD group). In our population, logarithmically transformed hs-cTnTs were independently associated with all-cause mortality at 24 months F/U (pre-TAVI hs-cTnT: Hazard ratio [HR] 2.2, 95% confidence interval [CI]: 1.1 to 4.4, p=0.027). No significant differences were observed between the MD and non-MD groups for the three endpoints of all cause death (p log rank: 0.15), cardiovascular death (p log rank: 0.86) and re-hospitalization (p log rank: 0.87). Conclusions: Only baseline hs-cTnT levels correlated with outcomes at 24 months of follow-up. Chronic pre-procedural myocardial injury significantly affects prognosis after TAVI
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1572462
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