Does Transcatheter Aortic Valve Replacement (TAVR) procedure elevate cardiac troponin levels?

From the Guidelines

Yes, TAVR procedures are associated with an elevation in troponin levels, as evidenced by the Valve Academic Research Consortium 3 definitions 1. The TAVR procedure involves manipulation within the heart, which can cause minor myocardial injury, leading to a rise in troponin levels. According to the study, periprocedural biomarker elevation >ULN not meeting the criteria for MI should be categorized as ‘myocardial injury not meeting MI criteria’ 1. Key points to consider include:

• The degree of troponin elevation varies widely among patients, with studies showing that nearly all TAVR patients experience some level of troponin increase post-procedure.
• The troponin rise usually peaks within 24-48 hours after the procedure and then gradually decreases.
• Extremely high levels may indicate procedural complications such as coronary obstruction or significant myocardial damage.
• Clinicians should interpret post-TAVR troponin elevations in context with other clinical findings rather than as an isolated value.
• The presence of troponin elevation alone does not necessarily indicate a poor outcome, but the magnitude of elevation may correlate with procedural complexity and patient risk factors, as outlined in the Valve Academic Research Consortium 3 definitions 1.

From the Research

TAVR Procedure and Troponin Elevation

• The TAVR procedure has been associated with elevations in troponin levels, which can be indicative of myocardial injury 2, 3.
• Studies have shown that post-procedural increases in serum troponin-T level are associated with adverse clinical outcomes, including higher rates of 30-day adverse events and 2-year cumulative incidence of cardiovascular death or heart failure readmissions 2.
• The prognostic impact of troponin elevation after TAVR has been investigated, with findings suggesting that troponin T elevation ≥3× upper limit of normal is associated with increased long-term mortality after TAVR 3.

Predictive Value of Troponin Elevation

• Pre-procedural elevated cardiac troponin has been found to predict risk of long-term all-cause mortality after TAVR, with a meta-analysis showing a hazard ratio of 2.25 for increased risk of long-term mortality 4.
• High-sensitivity cardiac troponin T has been shown to be strongly associated with all-cause death and rehospitalization during 3-year follow-up after TAVR, with consistent differences between troponin strata for all-cause death and rehospitalization 5.

Clinical Implications

• The association between troponin elevation and outcome after TAVR is independent of coronary artery disease or low aortic valve gradient 5.
• The management of coexistent coronary artery disease, prevention of periprocedural stroke, and issue of durability are remaining challenges in TAVR, particularly for low-risk, younger patients 6.
• The use of TAVR has increased rapidly, with equivalent or superior outcomes compared to traditional surgical aortic valve replacement (SAVR), and indications have recently expanded to include patients considered to be at low risk for SAVR 6.