OR3-7 | High-Sensitivity Cardiac Troponin-T as a Prognostic Indicator of Mortality and Functional Status in Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

High-sensitivity cardiac troponin-T (hs-cTnT) is a cardiac biomarker primarily utilized in the diagnosis and risk-stratification of patients with acute coronary syndrome. Its role in patients undergoing TAVR is less well studied. This is a single-center prospective study of 173 patients with severe AS (AVA<1.0 cm2) undergoing TAVR at a large medical center between January 1, 2020 and January 1, 2022. The primary endpoint was mortality at 1-year. Secondary endpoints were change in quality of life as assessed by change in Kansas City Questionnaire (KCCQ) scores and change in functional status as assessed by change in distance traveled on a 6-minute walk test (6MWD), from baseline to 30-days and 1-year after TAVR. Blood samples for the assessment of hs-cTnT levels were obtained at baseline, 30-days, and one- year after TAVR. Mortality was observed in 13/173 (7.5%) patients within 1-year of TAVR. The mean age of the cohort was 75.6±12.2 years and 53.8% were male. The baseline hs-cTnT was 25.46±22.93 ng/L. Following TAVR, there was a significant reduction of hs-cTnT by 2.9±10.6 ng/L at 30-days (p=0.007). Pre-TAVR baseline levels of hs-cTnT were significantly higher among those who died vs were alive at 1-year (44.3±29.0 ng/L vs. 23.9±21.7 ng/L, p=0.007). Patients in the highest hs-cTnT tertile (hs-cTnT 24.6-140 ng/L) at baseline had a higher mortality rate (14.3%) compared to those in the middle (hs-cTnT 14.1-24.5 ng/L; 5.5% mortality) and lowest (hs-cTnT 6.0-14.0 ng/L; 3.6% mortality) tertiles (p = 0.05).Δhs-cTnT (30-day hs-cTnT–baseline hs-cTnT) was not associated with 1-year mortality. While TAVR was associated with an improvement in 30-day KCCQ (13.7±20.6), there was no association between baseline orΔhs-cTnT withΔKCCQ orΔ6MWD. Baseline hs-cTnT was significantly associated with all-cause 1-year mortality after TAVR, with the highest tertile patients having a 4-fold greater mortality than the lowest tertile. Baseline andΔhs-cTnT was not associated with changes in quality of life or functional status. These findings suggest baseline hs-cTnT may be a valuable component of a multi-parameter tool to enhance risk stratification and prognostication in patients undergoing TAVR.