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. 2021 Mar;110(3):421-428.
doi: 10.1007/s00392-020-01759-x. Epub 2020 Oct 24.

Elevated high-sensitivity troponin T levels at 1-year follow-up are associated with increased long-term mortality after TAVR

Hatim Seoudy #  1   2 , Moritz Lambers #  3 , Vincent Winkler  1 , Linnea Dudlik  1 , Sandra Freitag-Wolf  4 , Johanne Frank  1   2 , Christian Kuhn  1   2 , Ashraf Yusuf Rangrez  1   2 , Thomas Puehler  2   5 , Georg Lutter  2   5 , Peter Bramlage  6 , Norbert Frey  1   2 , Derk Frank  7   8
Affiliations

Elevated high-sensitivity troponin T levels at 1-year follow-up are associated with increased long-term mortality after TAVR

Hatim Seoudy et al. Clin Res Cardiol. 2021 Mar.

Abstract

Background: Elevated pre-procedural high-sensitivity troponin T (hs-TnT) levels predict adverse outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). It is unknown whether elevated troponin levels still provide prognostic information during follow-up after successful TAVR. We evaluated the long-term implications of elevated hs-TnT levels found at 1-year post-TAVR.

Methods and results: The study included 349 patients who underwent TAVR for severe AS from 2010-2019 and for whom 1-year hs-TnT levels were available. Any required percutaneous coronary interventions were performed > 1 week before TAVR. The primary endpoint was survival time starting at 1-year post-TAVR. Optimal hs-TnT cutoff for stratifying risk, identified by ROC analysis, was 39.4 pg/mL. 292 patients had hs-TnT < 39.4 pg/mL (median 18.3 pg/mL) and 57 had hs-TnT ≥ 39.4 pg/mL (median 51.2 pg/mL). The high hs-TnT group had a higher median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, greater left ventricular (LV) mass, higher prevalence of severe diastolic dysfunction, LV ejection fraction < 35%, severe renal dysfunction, and more men compared with the low hs-TnT group. All-cause mortality during follow-up after TAVR was significantly higher among patients who had hs-TnT ≥ 39.4 pg/mL compared with those who did not (mortality rate at 2 years post-TAVR: 12.3% vs. 4.1%, p = 0.010). Multivariate analysis identified 1-year hs-TnT ≥ 39.4 pg/mL (hazard ratio 2.93, 95% CI 1.91-4.49, p < 0.001), NT-proBNP level > 300 pg/mL, male sex, an eGFR < 60 mL/min/1.73 m2 and chronic obstructive pulmonary disease as independent risk factors for long-term mortality after TAVR.

Conclusions: Elevated hs-TnT concentrations at 1-year after TAVR were associated with a higher long-term mortality.

Keywords: Aortic stenosis; Survival; Transcatheter aortic valve replacement; Troponin T.

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Conflict of interest statement

Hatim Seoudy, Moritz Lambers, Linnea Dudlik, Vincent Winkler, Sandra-Freitag-Wolf, Johanne Frank, Christian Kuhn, and Ashraf Yusuf Rangrez declare no conflict of interest. Peter Bramlage received research funding and honoraria for his advisory role from Edwards Lifesciences and Abbott. Georg Lutter is a consultant for Edwards Lifesciences, Medtronic, BostonScientific, and Abbott. Norbert Frey declares no conflict of interest for this study, yet has received speaker honoraria from AstraZeneca, Bayer Healthcare, Boehringer Ingelheim, Edwards, and Novartis. Derk Frank is consultant for Edwards Lifesciences and Medtronic and has received research funding from Edwards Lifesciences.

Figures

Fig. 1
Fig. 1
Receiver operating characteristic curve analysis of high-sensitivity troponin T cut-off value. AUC area under the curve
Fig. 2
Fig. 2
Persistently elevated hs-TnT concentrations at 1 year after TAVR are associated with a higher mortality rates over the long-term. hs-TnT high-sensitivity troponin T, TAVR transcatheter aortic valve replacement
See this image and copyright information in PMC

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