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Published on: February 26, 2013
Troponin T Elevation After Percutaneous Left Atrial Appendage Occlusion
Xiaoyan Wang1, Xueying Chen1, Yong Ye2
1Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China.
Insights
Cardiac troponin T (cTNT) elevation is common after left atrial appendage occlusion (LAAO) but does not appear linked to adverse outcomes. Factors like device type and procedure details influence cTNT levels.
Area of Science:
- Cardiology
- Biomarkers
- Medical Devices
Background:
- Cardiac troponin T (cTNT) is a key indicator of cardiac damage, with elevated levels correlating to increased mortality in various heart conditions.
- Elevated cTNT is frequently observed post-left atrial appendage occlusion (LAAO).
Purpose of the Study:
- To investigate the incidence, clinical significance, and contributing factors of cTNT elevation following LAAO procedures.
- To assess the relationship between post-LAAO cTNT levels and major adverse cardiovascular events or periprocedural complications.
Main Methods:
- Prospective study of 190 patients undergoing LAAO from January 2019 to July 2020.
- Patients categorized based on post-procedure cTNT levels (elevated vs. normal).
- One-year follow-up for major adverse cardiovascular events (MACE) and periprocedural complications.
Main Results:
- A high incidence of cTNT elevation (85.3%) was observed after LAAO.
- Factors such as procedure duration, contrast dosage, LAAO device type, and LAA morphology influenced cTNT levels.
- Watchman device use was associated with higher cTNT elevation compared to Lambre device (89.2% vs. 76.7%, p=0.029).
- No significant difference in MACE or complications between groups with and without cTNT elevation (p-values > 0.05).
Conclusions:
- LAAO frequently results in cTNT elevation, which appears unrelated to 1-year adverse cardiac outcomes or complications.
- Baseline eGFR, procedural factors (exposure time, contrast dose), LAAO device type, and LAA anatomy are potential contributors to post-LAAO cTNT elevation.
Abstract:
Background: Cardiac troponin T (cTNT) has been widely used in detecting cardiac damage. Elevated cTNT level has been reported to be associated with increased mortality in multiple cardiac conditions. It is not uncommon to observe an increased level of cTNT in patients after left atrial appendage occlusion (LAAO). The objective of the study is to study the incidence, significance, and factors associated with cTNT elevation after LAAO. Methods: We prospectively included patients who underwent LAAO from January 2019 to July 2020 in Fudan Zhongshan Hospital. Patients were divided into those with elevated cTNT after procedure and those with normal postprocedure cTNT. All individuals were followed up for 1 year. The primary outcome is major adverse cardiovascular events, which include myocardial infarction, heart failure, cardiac death, and stroke. The second outcome is periprocedure complication, including chest pain, tachycardia, cardiac tamponade, change of electrocardiograph, and atrial thrombus. Results: A total of 190 patients were enrolled. Of the patients, 85.3% had elevated cTNT after LAAO, while 14.7% of them did not. Exposure time, dosage of contrast, types of devices, shapes, and sizes of LAA could contribute to elevated postprocedure cTNT. We found that patients with a Watchman device were more likely to have elevated postprocedure cTNT than those with a Lambre device (89.2 vs. 76.7%, p = 0.029). LAAO shapes were associated with cTNT levels in patients with a Watchman device, while the diameter of the outer disc and LAA depth mattered for the Lambre device. There was no significant difference in the primary and second outcome between the two groups (p-value: 0.619, 0.674). Conclusion: LAAO was found to be commonly accompanied with cTNT elevation, which might not to be related to the complications and adverse cardiac outcomes within 1 year of follow-up. Moreover, eGFR at baseline, exposure time, dosage of contrast, types of LAAO device, and LAA morphology could contribute to cTNT elevation.
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