Produção Nacional
Revisado por pares
Predictors and Impact of Myocardial Injury After Transcatheter Aortic Valve Replacement
2015; Elsevier BV; Volume: 66; Issue: 19 Linguagem: Inglês
10.1016/j.jacc.2015.08.881
ISSN1558-3597
AutoresHenrique Barbosa Ribeiro, Luis Nombela‐Franco, Antonio J. Muñoz-García, Pedro A. Lemos, Ignacio J. Amat‐Santos, Violeta Serra, Fábio Sândoli de Brito, Alexandre Abizaid, Rogério Sarmento‐Leite, Rishi Puri, Asim N. Cheema, Marc Ruel, Fabian Nietlispach, Francesco Maisano, César Morı́s, Raquel del Valle, Marina Ureña, Omar Abdul Jawad Altisent, María Del Trigo, Francisco Campelo‐Parada, Pilar Jiménez‐Quevedo, Juan H. Alonso‐Briales, Hipólito Gutiérrez, Bruno García del Blanco, Marco Perin, Dimytri Siqueira, Guilherme Bernardi, Éric Dumont, Mélanie Côté, Philippe Pîbarot, Josep Rodés‐Cabau,
Tópico(s)Cardiac Imaging and Diagnostics
ResumoCardiac biomarker release signifying myocardial injury post-transcatheter aortic valve replacement (TAVR) is common, yet its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown. This study sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation post TAVR. This multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical (TA) approaches were selected in 73.1% and 20.3% of patients, respectively. Creatine kinase-myocardial band (CK-MB) measurements were obtained at baseline and at several time points within the initial 72 h post TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up. Overall, 66% of the TAVR population demonstrated some degree of myocardial injury as determined by a rise in CK-MB levels (peak value: 1.6-fold [interquartile range (IQR): 0.9 to 2.8-fold]). A TA approach and major procedural complications were independently associated with higher peak of CK-MB levels (p < 0.01 for all), which translated into impaired systolic left ventricular function at 6 to 12 months post TAVR (p < 0.01). A greater rise in CK-MB levels independently associated with an increased 30-day, late (median of 21 [IQR: 8 to 36] months) overall and cardiovascular mortality (p < 0.001 for all). Any increase in CK-MB levels was associated with poorer clinical outcomes, and there was a stepwise rise in late mortality according to the various degrees of CK-MB increase after TAVR (p < 0.001). Some degree of myocardial injury was detected in two-thirds of patients post TAVR, especially in those undergoing TA-TAVR or presenting with major procedural complications. A greater rise in CK-MB levels associated with greater acute and late mortality, imparting a negative impact on left ventricular function.
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