Cardiac troponin I release after transcatheter closure of the interatrial septum: a prospective study.

Abstract

Objective — To identify cTnI rise after percutaneous ISD closure and to determine its prognostic significance.

Background — Cardiac troponin-I (cTnI) is a very specific and sensitive marker of myocardial injury. A significant increase of cTnI levels after percutaneous interatrial septal defect (ISD) closure has been reported.

Methods — Patients admitted for transcatheter atrial septal defect (ASD) and patent foramen ovale (PFO) closure, were enrolled in this prospective study. Standard protocol was unchanged, except for blood sampling, to which serial cTnI before, 6, and 24 hours after the procedure was added.

Results — Seventy-eight patients (female/male 37/41, mean age 55 ± 13 y, 14 ASD and 64 PFO) were included. In none of the patients cTnI was elevated before the procedure and in no patients a cTnI rise above the WHO-criteria for myocardial infarction (>= 0.4 ng/ml) was seen. However, in 32 patients (41%) minimal cTnI rise (range from 0.04 ng/ml to 0.37 ng/ml) was present within a time frame of 24 hours.The increase in cTnI was not related to peri-procedural complications and to short-term outcome (mean follow-up time of 7 ± 5 months).

In addition, cTnI rise was significantly related with the presence of hyperlipideamia (P = 0.004), device size (P = 0.008), and the absence of balloon sizing (P = 0.017).

Conclusions — Transcatheter closure of ISD seems to be a safe procedure. A minimal but significant increase of cTnI is noted in some patients after the procedure, but it seems not to be related to short-term prognosis. However, cTnI rise is clearly associated with patients’ characteristics and peri-procedural variables.

Key Words:

• atrial septal defect
• patent foramen ovale
• percutaneous intervention
• troponin