Preprocedural high-sensitive Troponin strongly predicts survival after Transcatheter Aortic Valve Implantation (TAVI)

Abstract

Transcatheter aortic valve implantation/replacement (TAVI/TAVR) 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 evaluate the perioperative and long-term risk of patients undergoing TAVI. However, exact estimation of risk remains difficult. We thus sought to investigate whether biomarkers may improve risk stratification. We prospectively included 111 consecutive patients undergoing TAVI at our institution from 02/2011 until 05/2012. 107 patients were available for follow-up. 61.7% were females, mean age was 81.63 years (±6.34y), and 56.1% 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) and other clinical and biochemical parameters were measured 24h before TAVI. Mean logistic Euroscore was 21.4% (±14.0%), and mean STS score was 6.6% (±4.1%). Mean follow-up was 249 days (±158d). The primary endpoint was all-cause mortality. A total of 21 deaths (19.6%) occurred during follow up. 30-day mortality was 7.5%. Median baseline hsTnT values were 23.5 ng/ml (IQR 12.9-48.4 ng/ml). hsTnT, NTproBNP, Euroscore, pre- and postprocedural aortic regurgitation (AR) were significantly associated with outcome. Interestingly, a multivariate analysis revealed that only hsTnT (HR upper quartile 5.1 vs. lower quartiles, CI 2.06-12.54, p<0.001) and to a lesser extent preprocedural AR (HR=2.30, CI 1.33-3.99, p=0.003) independently predict survival time. Taken together, elevation of hsTnT pre-TAVI is a novel and strong predictor of death in TAVI patients.