https://doi.org/10.1007/s00392-025-02625-4
1Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Herz- und Gefäßchirurgie Hamburg, Deutschland; 4Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Kardiologie Hamburg, Deutschland
Background:
Periprocedural myocardial injury is associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). Underlying mechanisms include access-related trauma, mechanical strain, and ischemia.Furthermore, preprocedural anemia may play a crucial role due to its impact on myocardial oxygen supply. Although anemia is recognized as an independent risk factor for mortality and morbidity in TAVI patients, its specific contribution to periprocedural myocardial injury remains uncertain.
Objectives:
This study aims to assess the association between preprocedural anemia and the extent of periprocedural myocardial injury, as measured by high-sensitivity troponin I (hsTnI) levels.
Methods:
A total of 997 consecutive patients provided with transfemoral TAVI at the University Heart and Vascular Center Hamburg between 2020 and 2023 with available baseline and postprocedural hsTnI values, were included in this analysis. Postprocedural hsTnI levels were measured between days 2 and 4 following the procedure. Patients were stratified into two groups based on hemoglobin (Hb) levels: Hb <11 g/dL (anemic, study group) and Hb ≥11 g/dL (non-anemic, control group).
Results:
Of 997 patients, 225 (22.6%) were identified as anemic (Hb <11 g/dL). No differences in age (median age 81.8 [77.7, 85.0] years) or sex distribution (58.4% male) were observed between groups. The study group presented with lower body mass index (25.2 [22.9, 28.4] vs. 26.1 [23.8, 29.5], p = 0.006), higher STS-Mortality Score (3.6 [2.5, 5.5] vs. 2.5 [1.7, 3.9], p <0.001), increased prevalence of cerebral artery disease (75.5% vs. 59.1%, p <0.001), higher rates of 3-vessel coronary artery disease (38.0% vs. 25.9%, p <0.001), and impaired renal function (GFR 54.7 [37.1, 71.1] vs. 62.6 [48.3, 78.4] mL/min/1.73 m², p <0.001). Baseline hsTnI levels were higher in anemic patients (24.0 [13.0, 63.0] vs. 18.0 [9.7, 45.0], p = 0.0013). Procedural characteristics did not differ between groups.
Postprocedural outcomes showed lower Pmean values in the study group (7.0 [5.0, 10.0] vs. 8.0 [5.0, 12.0] mmHg, p=0.05), but similar rates of paravalvular leakage. Also the VARC-3 adjudicated combined endpoint device success did not differ between groups. However, overall bleeding events were more frequent in the study group (11.7% vs. 2.8%, p <0.001), resulting in lower postprocedural Hb levels (8.9 [8.4, 9.5] vs. 11.2 [10.2, 11.2] g/dL, p = <0.001). Notably, no difference was observed in postprocedural hsTnI delta values between groups (218.0 [99.2, 500.9] vs. 239.0 [104.7, 481.0], p = 0.68, Figure 1).
Conclusions:
Preprocedural anemia is associated with a particularly comorbid patient population and elevated baseline troponin levels; however, it did not correlate with an increase in periprocedural myocardial injury, as measured by hsTnI delta values. Nonetheless, the higher bleeding rates observed in anemic patients highlight the importance of considering anemia in preoperative planning to adapt intraprocedural measures and improve outcomes in patients provided with TAVI.
Figure 1: Correlation between baseline hemoglobin levels and postprocedural hsTnI levels