Troponin T Elevation After Percutaneous Left Atrial Appendage Occlusion.

Xiaoyan Wang,Xueying Chen,Xin Deng,Xingxu Wang,Qingxing Chen,Jieyun You,Li Lin,Daxin Zhou,Yong Ye,Juan Peng,Junbo Ge,Jinyi Lin

doi:10.3389/fcvm.2021.721224

Abstract

Background: Cardiac troponin T (cTNT) has been widely used in detecting cardiac damage. Elevated cTNT level has been reported to be associated with increased mortality in multiple cardiac conditions. It is not uncommon to observe an increased level of cTNT in patients after left atrial appendage occlusion (LAAO). The objective of the study is to study the incidence, significance, and factors associated with cTNT elevation after LAAO.Methods: We prospectively included patients who underwent LAAO from January 2019 to July 2020 in Fudan Zhongshan Hospital. Patients were divided into those with elevated cTNT after procedure and those with normal postprocedure cTNT. All individuals were followed up for 1 year. The primary outcome is major adverse cardiovascular events, which include myocardial infarction, heart failure, cardiac death, and stroke. The second outcome is periprocedure complication, including chest pain, tachycardia, cardiac tamponade, change of electrocardiograph, and atrial thrombus.Results: A total of 190 patients were enrolled. Of the patients, 85.3% had elevated cTNT after LAAO, while 14.7% of them did not. Exposure time, dosage of contrast, types of devices, shapes, and sizes of LAA could contribute to elevated postprocedure cTNT. We found that patients with a Watchman device were more likely to have elevated postprocedure cTNT than those with a Lambre device (89.2 vs. 76.7%, p = 0.029). LAAO shapes were associated with cTNT levels in patients with a Watchman device, while the diameter of the outer disc and LAA depth mattered for the Lambre device. There was no significant difference in the primary and second outcome between the two groups (p-value: 0.619, 0.674).Conclusion: LAAO was found to be commonly accompanied with cTNT elevation, which might not to be related to the complications and adverse cardiac outcomes within 1 year of follow-up. Moreover, eGFR at baseline, exposure time, dosage of contrast, types of LAAO device, and LAA morphology could contribute to cTNT elevation.

Highlights

Cardiac troponin T are part of the cardiac contractile mechanism of the cardiac muscle, and they are highly sensitive in detecting minimal myocardial injury [1]
Higher Cardiac troponin T (cTNT) levels can be found in various conditions, such as percutaneous coronary intervention (PCI) [2, 3], coronary artery bypass grafting (CABG) [1, 4, 5], radiofrequency catheter ablation (RFA) [6,7,8], automatic implantable cardioverter defibrillator (ICD) [9, 10], pacemaker lead insertion [11], and have been shown to be associated with worse clinical outcomes [1, 12, 13]
About 85.3% of the patients were in the group of elevated cTNT, while 14.7% of them were in the group of normal cTNT, among which 55.8% had a mild increase and 29.5% had a severe increase in cTNT (Figure 1)

Summary

Introduction

Cardiac troponin T (cTNTs) are part of the cardiac contractile mechanism of the cardiac muscle, and they are highly sensitive in detecting minimal myocardial injury [1]. For cardiac procedures like PCI and CABG, elevated cTNT levels after procedure is associated with worse clinical outcomes [2,3,4,5]; for other cardiac procedures, increased postprocedure cTNT levels do not necessarily affect adverse clinical outcomes [8]. It remains controversial whether increased cTNT values after cardiac procedure affect long-term adverse events. Left atrial appendage occlusion (LAAO) has emerged as a new strategy to prevent stroke in patients with atrial fibrillation (AF) [14, 15]. The objective of the study is to study the incidence, significance, and factors associated with cTNT elevation after LAAO

Objectives

Methods

Results

Discussion

Conclusion