Predictors and prognostic implications of myocaardial injury after transcatheter aortic valve implantation for severe aortic stenosis

Objectives: Transcatheter aortic valve implantation (TAVİ) is an emerging technique for management of symptomatic severe aortic stenosis. Myocardial injury is a common condition after TAVİ as in other percutaneous cardiac interventions. The purpose of this study is to define the precipitating factors and prognostic implications of myocardial injury after TAVİ. Materials and Methods: In this study, 188 patients that meet the inclusion criteria were investigated retropectively among 474 patients who underwent TAVİ procedure in Ankara Yıldırım Beyazıt University, Department of Cardiology between June 2011 and June 2018. Basal demographic characteristics, echocardiographic data, procedural data and aortic root dimensions obtained from multislice coronary cardiac tomography (CT) were evaluated by univariate analysis for predictors of myocardial injury. All variables that are significant for development of myocardial injury in univariate analysis (p<0.05) were entered into a multivariate logistic regression analysis model. Plasma levels of high sensitive troponin T and creatin kinase- MB are used for diagnosis of myocardial injury according to the VARC-2 criteria. Results; Myocardial injury detected by rise of plasma levels of HsTnT was found to be associated with advanced age [Odds Ratio (OR): 1.054 (% 95 Confidence interval (CI): 1.013-1.098 p=0.010)], transcatheteter heart valve type (LOTUS) [OR: 10.207 (% 95 CI: 2.861-36.463 p=0.001)], aortic annulus-right coronary artery distance measured by MSCT [OR: 0.853 (% 95 CI: 0.731-0.995 p=0.043)] aortic annulus-left main coronary artery distance measured by MSCT [OR: 0.747 (% 95 CI: 0.66-0.906 p=0.003)] and basal GFR values [OR: 0.985 (% 95 CI: 0.970-1.000 p=0.044)]. Myocardial injury detected by rise of plasma levels of CK-MB was found to be associated with advanced age [OR: 1.062 (% 95 CI: 1.005-1.230 p=0.031)] and transcatheteter heart valve type (LOTUS) [OR: 8.772 (% 95 CI: 3.166-24.307 p=0.001)]. Myocardial injury detected with the rise of both cardiac biomarkers are found to be associated with delayed discharge from hospital after procedure (For CK-MB p=0.015, for HsTnT p=0.001) and increased risk of permenant pacemaker implantation (For CK-MB p=0.001, for HsTnT p=0.043). Additionally presence of myocardial injury detected by elevation of CKMB levels is found to be associated with increased in-hospital mortality rates(p=0.001). Conclusions: Advanced age, transcatheter heart valve type, basal GFR values, aortic annulus-LMCA and aortic annulus-RCA distance measured by MSCT are found to be associated with increased risk of myocardial injury after TAVİ. We also found that occurence of myocardial injury is related with increased risk of permenant pacemaker implantation, delayed discharge from hospital and in-hospital mortality (statistical significance only for CK-MB related myocardial injury for the latter).