Multi-Biomarker Approach as Prognostic Tool In Patients With Severe Aortic Stenosis Undergoing Surgical Valve Replacement
Ricardo A. Spampinato, Rafal Bochen, Franz Sieg, Konstantin von Aspern, Josephina Haunschild, Elfriede Strotdrees, Sven Lehmann, Christian Etz, Michael A. Borger.
Heart center Leipzig, Leipzig, Germany.
OBJECTIVE: It has been demonstrated the prognostic utility of isolated biomarkers in aortic stenosis (AS). We aimed to determine whether the combination of multiple biomarkers (of cardiovascular stress, inflammation, and damage) has a better prognostic utility in patients with AS undergoing aortic valve replacement (AVR). METHODS: From a prospective registry of patients with AS referred for surgical AVR, 499 participants (68±8.5years; 292men) with available preoperative echocardiograms and biomarkers were retrospectively included. NT-pro-B-type natriuretic peptide (NTproBNP), high-sensitivity cardiac troponin T (hs-TNT), and C-reactive protein (CRP) were preoperative dichotomized based on median value as “high vs. low”, and introduced in a Cox proportional hazards model for all-cause mortality. Mean follow-up was 775±410days and 25(5%) patients died. RESULTS: Only the combination of three biomarkers was associated with increased mortality (referent: 0 elevated, n=94): 1 elevated, n=152 (HR 0.23, 95%CI 0.05 to 1.21, p=0.08), 2 elevated, n=150 (HR 0.49, 95%CI 0.13 to 1.80, p=0.28) and 3 elevated, n=103 (HR 2.82, 95%CI 1.02 to 7.83, p=0.047). Patients with 3 biomarkers were older (71±7.4 vs. 67±8.7years, p<0.0001), were more likely to have previous history of renal injury (20[19.4%] vs. 34[8.6%]; p=0.004), worse functional class (NYHA III-IV: 50.5% vs. 31.6%, p<0.001), a higher logistic-EuroScore (3.8±2.3 vs. 2.9±2.2, p=0.001), but comparable coronary artery disease. They had more severe AS (AV area index 0.35±0.09 vs. 0.38±0.08cm2/m2; p=0.002), but no differences in mean gradients (50.9±15.6 vs. 50.4±14.5mmHg, p=0.78), reflecting worse LV function: LVEF (53±14 vs. 60±9%; p<0.0001), longitudinal strain (GLPS -13.3±4.5 vs. -16.8±3.8%; p<0.0001), and stroke volume index (36.5±11 vs. 41±9.4ml/m2, p<0.0001). There were no differences in surgery characteristics. Finally, the combination of 3 biomarkers was associated with a higher 3-year all-cause mortality (16.9% vs. 3.2%, p<0.0001), and after adjustment for age, sex, comorbidities, AS severity, logistic-EuroScore, NYHA, LVEF, and GLPS, remained as an independent predictor. CONCLUSIONS: This study demonstrates the potential utility as a prognostic tool of a multi-biomarker approach in patients with AS who underwent surgical AVR. Further prospective studies should confirm these findings.
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