PMID- 31624275
OWN - NLM
STAT- MEDLINE
DCOM- 20201106
LR  - 20210110
IS  - 2045-2322 (Electronic)
IS  - 2045-2322 (Linking)
VI  - 9
IP  - 1
DP  - 2019 Oct 17
TI  - Utility of High-Sensitivity and Conventional Troponin in Patients Undergoing 
      Transcatheter Aortic Valve Replacement: Incremental Prognostic Value to B-type 
      Natriuretic Peptide.
PG  - 14936
LID - 10.1038/s41598-019-51371-x [doi]
LID - 14936
AB  - 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.
FAU - Kobayashi, Yukari
AU  - Kobayashi Y
AD  - Division of Cardiovascular Medicine, Stanford University School of Medicine, 
      Stanford, CA, United States. yukariko@stanford.edu.
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States. 
      yukariko@stanford.edu.
FAU - Kim, Juyong B
AU  - Kim JB
AD  - Division of Cardiovascular Medicine, Stanford University School of Medicine, 
      Stanford, CA, United States.
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States.
FAU - Moneghetti, Kegan J
AU  - Moneghetti KJ
AD  - Division of Cardiovascular Medicine, Stanford University School of Medicine, 
      Stanford, CA, United States.
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States.
FAU - Fischbein, Michael
AU  - Fischbein M
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States.
AD  - Division of Cardiothoracic Surgery, Stanford University School of Medicine, 
      Stanford, CA, United States.
FAU - Lee, Anson
AU  - Lee A
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States.
AD  - Division of Cardiothoracic Surgery, Stanford University School of Medicine, 
      Stanford, CA, United States.
FAU - Watkins, Claire A
AU  - Watkins CA
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States.
AD  - Division of Cardiothoracic Surgery, Stanford University School of Medicine, 
      Stanford, CA, United States.
FAU - Yeung, Alan C
AU  - Yeung AC
AD  - Division of Cardiovascular Medicine, Stanford University School of Medicine, 
      Stanford, CA, United States.
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States.
FAU - Liang, David
AU  - Liang D
AD  - Division of Cardiovascular Medicine, Stanford University School of Medicine, 
      Stanford, CA, United States.
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States.
FAU - Ozen, Mehmet O
AU  - Ozen MO
AD  - Division of Cardiothoracic Surgery, Stanford University School of Medicine, 
      Stanford, CA, United States.
AD  - Bio-Acoustic-MEMS in Medicine (BAMM) Laboratories, Canary Center at Stanford for 
      Cancer Early Detection, Department of Radiology, Stanford University School of 
      Medicine, Palo Alto, CA, United States.
FAU - Demirci, Utkan
AU  - Demirci U
AUID- ORCID: 0000-0003-2784-1590
AD  - Division of Cardiothoracic Surgery, Stanford University School of Medicine, 
      Stanford, CA, United States.
AD  - Bio-Acoustic-MEMS in Medicine (BAMM) Laboratories, Canary Center at Stanford for 
      Cancer Early Detection, Department of Radiology, Stanford University School of 
      Medicine, Palo Alto, CA, United States.
FAU - Bowen, Raffick
AU  - Bowen R
AD  - Department of Pathology, Stanford University School of Medicine, Stanford, CA, 
      United States.
FAU - Fearon, William F
AU  - Fearon WF
AD  - Division of Cardiovascular Medicine, Stanford University School of Medicine, 
      Stanford, CA, United States.
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States.
FAU - Haddad, Francois
AU  - Haddad F
AD  - Division of Cardiovascular Medicine, Stanford University School of Medicine, 
      Stanford, CA, United States.
AD  - Stanford Cardiovascular Institute, Stanford, CA, United States.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20191017
PL  - England
TA  - Sci Rep
JT  - Scientific reports
JID - 101563288
RN  - 0 (Biomarkers)
RN  - 0 (Troponin I)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/blood/diagnosis/mortality/*surgery
MH  - Biomarkers/blood
MH  - Echocardiography
MH  - Feasibility Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Natriuretic Peptide, Brain/*blood
MH  - Preoperative Period
MH  - Prognosis
MH  - Prospective Studies
MH  - Reference Values
MH  - Risk Assessment/methods
MH  - Severity of Illness Index
MH  - *Transcatheter Aortic Valve Replacement
MH  - Treatment Outcome
MH  - Troponin I/*blood
MH  - Ventricular Dysfunction/blood/*diagnosis/mortality/surgery
MH  - Ventricular Function, Left/physiology
PMC - PMC6797771
COIS- The authors declare no competing interests.
EDAT- 2019/10/19 06:00
MHDA- 2020/11/11 06:00
PMCR- 2019/10/17
CRDT- 2019/10/19 06:00
PHST- 2019/02/27 00:00 [received]
PHST- 2019/09/24 00:00 [accepted]
PHST- 2019/10/19 06:00 [entrez]
PHST- 2019/10/19 06:00 [pubmed]
PHST- 2020/11/11 06:00 [medline]
PHST- 2019/10/17 00:00 [pmc-release]
AID - 10.1038/s41598-019-51371-x [pii]
AID - 51371 [pii]
AID - 10.1038/s41598-019-51371-x [doi]
PST - epublish
SO  - Sci Rep. 2019 Oct 17;9(1):14936. doi: 10.1038/s41598-019-51371-x.