Study Analyzes Predictors and Impact of Myocardial Injury After TAVR

November 2, 2015—Findings from a study that sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation transcatheter aortic valve replacement (TAVR) were published by Henrique B. Ribeiro, MD, et al in the Journal of the American College of Cardiology (JACC, 2015;66:2075–2088). 

The background of the study is that cardiac biomarker release signifying myocardial injury after TAVR is common, but its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown.

As summarized in JACC, this multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical 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 hours after TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up.

The investigators reported that 66% of the TAVR population demonstrated some degree of myocardial injury as determined by an increase in CK-MB levels (peak value, 1.6-fold [interquartile range, 0.9–2.8-fold]). A transapical approach and major procedural complications were independently associated with higher peak of CK-MB levels (P < .01 for all), which translated into impaired systolic left ventricular function at 6 to 12 months post-TAVR (P < .01). 

A greater rise in CK-MB levels was independently associated with an increased 30-day, late (median, 21 months [interquartile range, 8–36 months]) overall and cardiovascular mortality (P < .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 < .001).

Some degree of myocardial injury was detected in two-thirds of patients post-TAVR, especially in those undergoing transapical 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, concluded the investigators in JACC.