Top

Published in:

01-01-2014 | Original Paper

Preserved prognostic value of preinterventional troponin T levels despite successful TAVI in patients with severe aortic stenosis

Authors: Emmanuel Chorianopoulos, Ulrike Krumsdorf, Nicolas Geis, Sven T. Pleger, Evangelos Giannitsis, Hugo A. Katus, Raffi Bekeredjian

Published in: Clinical Research in Cardiology | Issue 1/2014

Abstract

Background

Elevated concentrations of troponin T have prognostic impact in patients with various cardiovascular diseases including those with severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) has improved prognosis for patients without a surgical option. Whether this affects the prognostic value of preinterventional troponin T remains unclear.

Methods

We therefore conducted a prospective study in 198 consecutive patients with subsequent, successful transfemoral TAVI and analyzed cardiac troponin T (cTnT) levels with a new generation, high-sensitive troponin T assay before and after TAVI, as well as their prognostic value after 12 months.

Results

Patients with severe aortic stenosis (AS) showed significant elevation of preinterventional cTnT levels. Postinterventional cTnT levels significantly rose further about sevenfold after transfemoral TAVI and peaked at day three until they steadily declined thereafter. Baseline renal function (P = 0.011), the duration of intraprocedural rapid pacing (P = 0.0012), and baseline cTnT (P = 0.0001) values predicted the magnitude of postinterventional cTnT elevations. Interestingly, Kaplan–Meier curve analysis revealed, that although cTnT levels were not predictive for short-term mortality, preinterventional as well as postinterventional peak cTnT showed prognostic value for 1-year mortality, regardless of successful TAVI.

Conclusions

Pre- and postinterventional hscTnT levels signal adverse 1-year mortality in patients with severe AS independent of successful aortic valve replacement.

Thygesen K, Alpert JS, White HD (2007) Joint ESC/ACCF/AHA/WHF task force for the redefinition of myocardial infarction. Universal definition of myocardial infarction. Eur Heart J 28:2525–2538PubMedCrossRef

Hamm CW, Giannitsis E, Katus HA (2002) Cardiac troponin elevations in patients without acute coronary syndrome. Circulation 106:2871–2872PubMedCrossRef

Omland T, de Lemos JA, Sabatine MS, Christophi CA, Rice MM, Jablonski KA, Tjora S, Domanski MJ, Gersh BJ, Rouleau JL, Pfeffer MA, Braunwald E (2009) A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med 361:2538–2547PubMedCentralPubMedCrossRef

Defilippi CR, de Lemos JA, Christenson RH, Gottdiener JS, Kop WJ, Zhan M, Seliger SL (2010) Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA 304:2494–2502PubMedCentralPubMedCrossRef

Latini R, Masson S, Anand IS, Missov E, Carlson M, Vago T, Angelici L, Barlera S, Parrinello G, Maggioni AP, Tognoni G, Cohn JN (2007) Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation 116:1242–1249PubMedCrossRef

Lankeit M, Friesen D, Aschoff J, Dellas C, Hasenfuss G, Katus H, Konstantinides S, Giannitsis E (2010) Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism. Eur Heart J 31:1836–1844PubMedCrossRef

Giannitsis E, Becker M, Kurz K, Hess G, Zdunek D, Katus HA (2010) High-sensitivity cardiac troponin T for early prediction of evolving non-ST-segment elevation myocardial infarction in patients with suspected acute coronary syndrome and negative troponin results on admission. Clin Chem 56:642–650PubMedCrossRef

Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, Biedert S, Schaub N, Buerge C, Potocki M, Noveanu M, Breidthardt T, Twerenbold R, Winkler K, Bingisser R, Mueller C (2009) Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 361:858–867PubMedCrossRef

Røsjø H, Andreassen J, Edvardsen T, Omland T (2011) Prognostic usefulness of circulating high-sensitivity troponin T in aortic stenosis and relation to echocardiographic indexes of cardiac function and anatomy. Am J Cardiol 108:88–91PubMedCrossRef

10.

Otsuka T, Kawada T, Ibuki C, Seino Y (2010) Association between highsensitivity cardiac troponin T levels and the predicted cardiovascular risk in middle-aged men without overt cardiovascular disease. Am Heart J 159:972–978PubMedCrossRef

11.

de Lemos JA, Drazner MH, Omland T, Ayers CR, Khera A, Rohatgi A, Hashim I, Berry JD, Das SR, Morrow DA, McGuire DK (2010) Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA 304:2503–2512PubMedCrossRef

12.

Buellesfeld L, Wenaweser P, Gerckens U, Mueller R, Sauren B, Latsios G, Zickmann B, Hellige G, Windecker S, Grube E (2010) Transcatheter aortic valve implantation: predictors of procedural success—the Siegburg-Bern experience. Eur Heart J 31:984–991PubMedCrossRef

13.

De Jaegere PP, Piazza N, Galema TW, Otten A, Soliman OI, Van Dalen BM, Geleijnse ML, Kappetein AP, Garcia HM, Van Es GA, Serruys PW (2008) Early echocardiographic evaluation following percutaneous implantation with the self-expanding CoreValve revalving system aortic valve bioprosthesis. EuroIntervention 4:351–357PubMedCrossRef

14.

Piazza N, Grube E, Gerckens U, den Heijer P, Linke A, Luha O, Ramondo A, Ussia G, Wenaweser P, Windecker S, Laborde JC, de Jaegere P, Serruys PW (2008) Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention 4:242–249PubMedCrossRef

15.

Zajarias A, Cribier AG (2009) Outcomes and safety of percutaneous aortic valve replacement. J Am Coll Cardiol 53:1829–1836PubMedCrossRef

16.

Grube E, Schuler G, Buellesfeld L, Gerckens U, Linke A, Wenaweser P, Sauren B, Mohr FW, Walther T, Zickmann B, Iversen S, Felderhoff T, Cartier R, Bonan R (2007) Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome. J Am Coll Cardiol 50:69–76PubMedCrossRef

17.

Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S, PARTNER Trial Investigators (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607PubMedCrossRef

18.

Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ, PARTNER Trial Investigators (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198PubMedCrossRef

19.

Rodés-Cabau J, Webb JG, Cheung A, Ye J, Dumont E, Feindel CM, Osten M, Natarajan MK, Velianou JL, Martucci G, Devarennes B, Chisholm R, Peterson MD, Lichtenstein SV, Nietlispach F, Doyle D, Delarochellière R, Teoh K, Chu V, Dancea A, Lachapelle K, Cheema A, Latter D, Horlick E (2010) Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55:1080–1090PubMedCrossRef

20.

Rodés-Cabau J, Gutiérrez M, Bagur R, De Larochellière R, Doyle D, Côté M, Villeneuve J, Bertrand OF, Larose E, Manazzoni J, Pibarot P, Dumont E (2011) Incidence, predictive factors, and prognostic value of myocardial injury following uncomplicated transcatheter aortic valve implantation. J Am Coll Cardiol 57:1988–1999PubMedCrossRef

21.

Yong ZY, Wiegerinck EM, Boerlage-van Dijk K, Koch KT, Vis MM, Bouma BJ, Henriques JP, Cocchieri R, Piek JJ, de Mol BA, Baan J Jr (2012) Predictors and prognostic value of myocardial injury during transcatheter aortic valve implantation. Circ Cardiovasc Interv 5(3):415–423PubMedCrossRef

22.

Leon MB, Piazza N, Nikolsky E, Blackstone EH, Cutlip DE, Kappetein AP, Krucoff MW, Mack M, Mehran R, Miller C, Morel MA, Petersen J, Popma JJ, Takkenberg JJ, Vahanian A, van Es GA, Vranckx P, Webb JG, Windecker S, Serruys PW (2011) Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the valve academic research consortium. Eur Heart J 32:205–217PubMedCrossRef

23.

Carrabba N, Valenti R, Migliorini A, Vergara R, Parodi G, Antoniucci D (2013) Prognostic value of myocardial injury following transcatheter aortic valve implantation. Am J Cardiol 111:1475–1481PubMedCrossRef

24.

Vavuranakis M, Kariori M, Voudris V, Thomopoulou S, Aznaouridis K, Kalogeras K, Vrachatis D, Moldovan C, Dima I, Milkas A, Tousoulis D, Stefanadis C (2012) Troponin levels after TAVI are related to the development of distinct electrocardiographic changes. Int J Cardiol 167:606–608PubMedCrossRef

25.

Gannitsis E, Kurz K, Hallermayer K (2010) Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 56:254–261CrossRef

26.

Turer AT, Addo TA, Martin JL, Sabatine MS, Lewis GD, Gerszten RE, Keeley EC, Cigarroa JE, Lange RA, Hillis LD, de Lemos JA (2011) Myocardial ischemia induced by rapid atrial pacing causes troponin T release detectable by a highly sensitive assay: insights from a coronary sinus sampling study. J Am Coll Cardiol 57:2398–2405PubMedCentralPubMedCrossRef

27.

Goette A, Bukowska A, Dobrev D, Pfeiffenberger J, Morawietz H, Strugala D, Wiswedel I, Röhl FW, Wolke C, Bergmann S, Bramlage P, Ravens U, Lendeckel U (2009) Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur Heart J 30:1411–1420PubMedCrossRef

28.

Ben Yedder N, Roux JF, Paredes FA (2011) Troponin elevation in supraventricular tachycardia: primary dependence on heart rate. Can J Cardiol 27:105–109PubMedCrossRef

29.

Lund O, Kristensen LH, Baandrup U, Hansen OK, Nielsen TT, Emmertsen K, Jensen FT, Flø C, Rasmussen BS, Pilegaard HK (1998) Myocardial structure as a determinant of pre- and postoperative ventricular function and long-term prognosis after aortic valve replacement for aortic stenosis. Eur Heart J 19:1099–1108PubMedCrossRef

Title: Preserved prognostic value of preinterventional troponin T levels despite successful TAVI in patients with severe aortic stenosis
Authors: Emmanuel Chorianopoulos
Ulrike Krumsdorf
Nicolas Geis
Sven T. Pleger
Evangelos Giannitsis
Hugo A. Katus
Raffi Bekeredjian
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 1/2014
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-013-0624-8

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preserved prognostic value of preinterventional troponin T levels despite successful TAVI in patients with severe aortic stenosis

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

Primary prevention of sudden cardiac death in a low-risk child with familial hypertrophic cardiomyopathy: the role of cardiac magnetic resonance imaging

Closure of a coronary to pulmonary artery fistula by radiofrequency catheter ablation in the pulmonary artery

Association of vitamin D status and blood pressure response after renal denervation

Incidence and impact on prognosis of bleeding during percutaneous coronary interventions in patients with chronic kidney disease

Epidemiology of Chagas disease in Europe: many calculations, little knowledge

Prevalence of different forms of infarct-atypical late gadolinium enhancement in patients early and late after heart transplantation

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page