Key result
A lower threshold of high-sensitivity troponin I (6 ng/L) significantly predicted overall mortality (p=0.03) and improved risk stratification when combined with B-type natriuretic peptide (p=0.004) in patients undergoing TAVR.
Why the study?
Few studies have compared intermediate and high-sensitivity troponin in patients undergoing TAVR, and uncertainty remains regarding which thresholds best discriminate ventricular dysfunction or outcomes.
Does high-sensitivity troponin I assessment predict ventricular dysfunction and overall mortality in patients undergoing TAVR?
Observational (n=105)
No
Does high-sensitivity troponin I assessment predict ventricular dysfunction and overall mortality in patients undergoing TAVR?
In patients undergoing TAVR, a lower threshold of high-sensitivity troponin I, especially when combined with BNP, provides better prognostic value for long-term mortality than standard recommended thresholds.
High-sensitivity Troponin (hs-Tn) has emerged as a useful marker for patients with myocardial injury or heart failure. However, few studies have compared intermediate and hs-Tn in patients undergoing transcatheter aortic valve replacement (TAVR). Moreover, there remains uncertainty of which thresholds are the most useful for discriminating ventricular dysfunction or outcome. In this study we prospectively enrolled 105 patients with severe aortic stenosis (AS) who underwent TAVR as well as blood sampling for high-sensitivity (hs-TnI) and conventional troponin I (EXL-LOCI and RXL) assessment. Patients underwent comprehensive pre-procedure echocardiography. Ventricular dysfunction was defined using left ventricular mass index (LVMI), LV global longitudinal strain (LVGLS) and LV end-diastolic pressure. The mean age was 84.0 ± 8.7 years old and 60% were male sex with mean transaortic pressure gradient of 50.1 ± 16.0 mmHg and AVA of 0.63 ± 0.19 cm 2 . When using a threshold of 6 ng/L, 77% had positive hs-TnI while 27% had positive hs-TnI using recommended thresholds (16 ng/L for female and 34 ng/L for male). Troponin levels were higher in the presence of abnormal LV phenotypes. The strongest correlate of troponin was LVMI. During median follow-up of 375 days, 21 patients (20%) died. Lower threshold of hs-TnI and EXL-TnI was more discriminatory for overall mortality (Log-rank P = 0.03 for both), while higher threshold of hs-TnI (p = 0.75) and RXL-TnI were not (p = 0.30). Combining hs-TnI and BNP improved to predict long-term outcome (p = 0.004). In conclusion, hs-TnI levels correlated with the degree of LV dysfunction phenotypes. Furthermore, applying a lower threshold for hs-TnI performed better for outcome prediction than a recommended threshold in patients undergoing TAVR. Combining hs-TnI with BNP helped better risk stratification.
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Kobayashi et al. (2019) conducted an observational in Severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) (n=105). High-sensitivity Troponin I (hs-TnI) and B-type natriuretic peptide (BNP) assessment vs. Conventional Troponin I and standard hs-TnI thresholds was evaluated on Overall mortality (p=0.03). A lower threshold of high-sensitivity troponin I (6 ng/L) significantly predicted overall mortality (p=0.03) and improved risk stratification when combined with B-type natriuretic peptide (p=0.004) in patients undergoing TAVR.
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