{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T13:15:53Z","timestamp":1784121353700,"version":"3.55.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,7,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Troponin elevation occurs commonly in the setting of transcatheter aortic valve replacement (TAVR). There is a lack of information on the extent of troponin elevation post TAVR that is prognostically significant. We assessed the optimal cutoff for post\u2010TAVR troponin T elevation that correlates with long\u2010term mortality. We also examined the relationship between coronary artery disease (CAD) and prognostically significant myocardial injury in TAVR.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This is a retrospective, observational single\u2010center study involving patients who underwent TAVR at Cleveland Clinic between 2010 and 2015. Five hundred ten patients were included (mean follow\u2010up of 2.6\u00b11.3\u00a0years). Receiver operating characteristic analysis showed that troponin T elevation \u22653\u00d7 upper limit of normal was the best predictor of long\u2010term mortality post TAVR with area under the curve of 0.57, with transapical TAVR patients excluded. Multivariate analyses confirmed that troponin T elevation \u22653\u00d7 upper limit of normal was significantly associated with increased long\u2010term mortality post TAVR (hazard ratio 1.57, CI 1.04\u20132.38,\n              <jats:italic>P<\/jats:italic>\n              =0.03). The most common causes for the presence of unrevascularized CAD included the presence of chronic total occlusion in the native\/graft vessels (49.7%) and diffuse\/complex CAD unsuitable for PCI (24.6%). The presence of unrevascularized CAD and significant left main disease correlated with increased mortality, but not with the presence of prognostically significant myocardial injury.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Troponin T elevation of\n              <jats:bold>\u2265<\/jats:bold>\n              3\u00d7 upper limit of normal is associated with increased long\u2010term mortality after TAVR, except for the transapical approach. This prognostically significant myocardial injury does not appear to be secondary to severe CAD\/unrevascularized CAD or left main disease, but rather is associated with other factors such as post\u2010TAVR complications.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.011889","type":"journal-article","created":{"date-parts":[[2019,7,3]],"date-time":"2019-07-03T09:10:29Z","timestamp":1562145029000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Prognostically Significant Myocardial Injury in Patients Undergoing\u00a0Transcatheter Aortic Valve Replacement"],"prefix":"10.1161","volume":"8","author":[{"given":"Vikram","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Hospital Medicine The Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanujit","family":"Dey","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Lerner Research Institute The Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kesavan","family":"Sankaramangalam","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute The Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shehab A. R.","family":"Alansari","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine The Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine The Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Mick","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute The Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amar","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute The Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars G.","family":"Svensson","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute The Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute The Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.10.050"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.08.1666"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1514616"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30073-3"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.01.096"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.11.060"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.12.059"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.06.018"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.01.029"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.881"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.09.002"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002430"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.111.964882"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.006092"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(85)80005-X"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.39.7.733"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3623"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.08.1038"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx383"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJY15M02_02"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005070"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJY14M05_09"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.12.033"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.03.062"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.118.011889","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:05:04Z","timestamp":1715598304000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.118.011889"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,16]]},"references-count":25,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2019,7,16]]}},"alternative-id":["10.1161\/JAHA.118.011889"],"URL":"https:\/\/doi.org\/10.1161\/jaha.118.011889","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,16]]},"assertion":[{"value":"2019-01-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e011889"}}