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Transient elevation of high-sensitive troponin T after Cardioband implantation

Transienter Anstieg des hochsensitiven Troponin T nach Cardioband-Implantation

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Abstract

Background

The Cardioband system enables percutaneous surgical-like direct mitral valve annuloplasty and, thereby, repair of severe functional mitral valve regurgitation (MR) in patients with advanced systolic heart failure (HF) and dilation of the left ventricular (LV) annulus. Since the device is anchored by screws in the LV annulus, limited myocardial injury is likely to occur.

Methods and results

Five patients (Society of Thoracic Surgeons score: 2.7 ± 0.7%) with severe HF (LV ejection fraction [LVEF]: 17 ± 1%; LV end-diastolic diameter [LVEDD]: 71 ± 3 mm) were treated with the Cardioband (sizes C–F) receiving 14–17 screws in the LV annulus region. Myocardial injury was monitored by measuring high-sensitive cardiac troponin T (hsTnT) levels and by echocardiography. All patients showed significant periprocedural increase in hsTnT levels. Peak hsTnT concentration was reached between day 1 and day 6 (593 ± 141 pg/ml). None of the patients showed clinical signs of myocardial infarction, ST-segment elevation, new onset of deteriorated myocardial wall motion, or new ventricular tachycardia. hsTnT levels normalized in all patients after 14 days (hsTnT on day 0: 34 ± 6 pg/ml vs. hsTnT on day 14: 36 ± 6 pg/ml; p = 0.604). This nonischemic hsTnT kinetics was compared to a sixth patient who experienced proximal damage of the left circumflex artery (LCX) and ST-segment elevation during the Cardioband procedure, followed by immediate repair of the LCX, avoiding structural damage of the LV.

Conclusion

Cardioband implantation is accompanied by significant elevation of hsTnT without causing structural myocardial damage or clinical symptoms such as worsening of LV function, new-onset LV regions exhibiting reduced wall motion, or ventricular tachycardia.

Zusammenfassung

Hintergrund

Vergleichbar mit einer operativen Mitralklappenrekonstruktion ermöglicht das Cardioband-System eine perkutane direkte Mitralklappenanuloplastie und somit eine Rekonstruktion bei schwerer funktioneller Mitralklappeninsuffizienz (MR), inbesondere bei Patienten mit fortgeschrittener systolischer Herzinsuffizienz und Dilatation des linken Ventrikels (LV). Da das Cardioband-System mittels Schrauben im LV-Anulus verankert wird, ist das Auftreten einer begrenzten Myokardschädigung durch den Eingriff wahrscheinlich.

Methoden und Ergebnisse

Mittels des Cardioband-Systems (Größe C–F) wurden 5 Patienten (Score gemäß Society of Thoracic Surgeons: 2,7 ± 0,7 %) mit schwerer Herzinsuffizienz (LV-Ejektionsfraktion, LVEF: 17 ± 1 %; LV enddiastolischer Durchmesser, LVEDD: 71 ± 3 mm) behandelt. Dabei wurden 14–17 Schrauben in die LV-Anulusregion inseriert. Das Ausmaß der Myokardschädigung wurde mittels hochsensitivem kardialen Troponin T (hsTnT) und Echokardiographie gemonitort. Alle Patienten wiesen einen signifikanten periprozeduralen Anstieg der hsTnT-Werte auf. Die höchsten Werte für hsTnT wurden zwischen Tag 1 und Tag 6 erreicht (593 ± 141 pg/ml). Bei keinem der Patienten bestanden klinische Symptome eines Herzinfarkts, eine ST-Streckenhebung, neu aufgetretende regionale Wandbewegunsstörungen oder ventrikuläre Rhythmusstörungen. Die hsTnT-Werte normalisierten sich bei allen Patienten nach 14 Tagen (hsTnT an Tag 0: 34 ± 6 pg/ml vs. hsTnT an Tag 14: 36 ± 6 pg/ml; p = 0,604). Diese hsTnT-Kinetik wurde mit der eines 6. Patienten verglichen, bei dem intraprozedural eine proximale Verletzung der linken Arteria circumflexa (LCX) mit konsekutiver ST-Streckenhebung während der Cardioband-Implantation auftrat. Durch eine unmittelbare Intervention der LCX konnte ein struktureller Schaden vermieden wurde.

Schlussfolgerung

Die Cardioband-Implantation geht mit einer signifikanten Erhöhung des hsTnT einher, ohne einen strukturellen Myokardschaden oder klinische Symptome wie die Verschlechterung der LV-Funktion, regionale Wandbewegungsstörungen oder ventrikuläre Rhythmusstörungen zu verursachen.

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Authors and Affiliations

  1. Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    M. M. Kreusser MD, S. T. Pleger MD, H. Abu Sharar MD, N. A. Geis MD, R. Bekeredjian MD, H. A. Katus MD & P. W. Raake MD

  2. DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg/Mannheim, Heidelberg, Germany

    M. M. Kreusser MD, S. T. Pleger MD, R. Bekeredjian MD & H. A. Katus MD

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  1. M. M. Kreusser MD
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  2. S. T. Pleger MD
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Correspondence to M. M. Kreusser MD.

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Conflict of interest

M.M. Kreusser, S.T. Pleger, H. Abu Sharar, N.A. Geis, R. Bekeredjian, H.A. Katus, and P.W. Raake declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was in accordance with the local ethics committee (Heidelberg). Informed consent was obtained from all individual participants included in the study.

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M.M. Kreusser and S.T. Pleger contributed equally and should be considered as joint first authors.

All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors. All authors have approved the manuscript.

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Kreusser, M.M., Pleger, S.T., Abu Sharar, H. et al. Transient elevation of high-sensitive troponin T after Cardioband implantation. Herz 44, 546–552 (2019). https://doi.org/10.1007/s00059-018-4754-7

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