Abstract 18505: High-sensitive Troponin T Levels Independently Predict Survival in TAVI Patients

Abstract

TAVI (transcatheter aortic valve implantation) has become a valuable therapeutic tool in the treatment of inoperable or high risk patients with severe aortic stenosis. Several risk scores have been proposed to estimate the perioperative and long-term risk of patients undergoing TAVI. However, exact estimation of perioperative and long term risk remains difficult. We thus sought to investigate whether biomarkers may improve risk stratification in this setting. We included 111 consecutive patients undergoing TAVI (using Edwards Sapien and Sapien XT prostheses) at our institution from February 2011 until May 2012. 109 patients were available for complete follow up. 61% were females, mean age was 80.6 years (+/- 11.0 years), 55% were treated via transfemoral access. Since elevated troponin T levels have been associated with adverse outcome in various forms of cardiac disease, high sensitive troponin T (hsTNT) values and other parameters were measured a day before TAVI (baseline) and 1, 3, and 7 days post-procedure. Mean EF was 48.3% (+/- 10.3%) and mean logistic Euroscore 20.8% (+/- 13.1%). Mean follow-up was 163 days (+/-144 days), The primary endpoint was all-cause mortality and a total of 18 deaths (16.51%) occurred. 30 day mortality was 6.4% (7/109). Median baseline hsTNT values were 22.7 ng/ml with an interquartile range (IQR) of 12-47 ng/ml. Cox regression analyses including age, sex, procedural access site, NYHA class, renal function [creatinine], NTproBNP, STS score, and logistic Euroscore revealed only baseline hsTNT (HR for upper quartile 6.32 vs. quartiles 1-3, CI 2.15-18.55, p=0.001) and the baseline creatinine level (HR=1.89 per quartile, CI 1.02-3.48, p=0.043) as independent prognostic parameters for cumulative mortality. At 72 hours post-TAVI, hsTNT increased to a median of 178 ng/ml, IQR 88.7-361.52 ng/ml. hsTNT levels at day 3 were associated with adverse outcome, but did not offer additional prognostic information when compared to preprocedural hsTNT levels. However, the individual raise in hsTNT at day 3 is associated with the incidence of cumulative death (p=0.034). In conclusion, elevated hsTNT the day before TAVI is an independent risk predictor of all-cause death in TAVI patients.