Lutz Matthias, von Ingersleben Nora, Lambers Moritz, Rosenberg Mark, Freitag-Wolf Sandra, Dempfle Astrid, Lutter Georg, Frank Johanne, Bramlage Peter, Frey Norbert, Frank Derk
Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany.
German Centre for Cardiovascular Research, DZHK Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany.
Open Heart. 2017 Jun 10;4(2):e000633. doi: 10.1136/openhrt-2017-000633. eCollection 2017.
Osteopontin (OPN) is an extracellular matrix protein that plays an integral role in myocardial remodelling and has previously been shown to be a valuable biomarker in cardiovascular disease. Because of the concentric myocardial hypertrophy associated with severe, symptomatic aortic stenosis (AS), we hypothesised that OPN expression may have a prognostic value in patients undergoing transcatheter aortic valve implantation (TAVI).
We prospectively included 217 patients undergoing TAVI between February 2011 and December 2013 with a median follow-up of 349 days. Twenty healthy individuals from the same age range free from structural heart disease served as controls. The primary endpoint for the analysis was survival time.
Median preprocedural OPN levels (675 ng/mL; IQR 488.5-990.5 ng/mL) were significantly higher in patients with severe aortic valve stenosis compared with healthy controls (386 ng/mL; IQR 324.5-458, p<0.001). Patients with increased OPN values showed at baseline a decreased 6 min walk test performance, increased rates of atrial arrhythmia, and an increased risk of death during follow-up (HR 2.2; 95% CI 1.3 to 3.5 for the comparison of the highest vs lowest OPN quartile). Multiple Cox regression analysis demonstrated that OPN improves the prediction of an adverse prognosis further than N-terminal probrain natriuretic peptide.
OPN levels at baseline are associated with adverse outcomes in patients with severe, symptomatic AS undergoing TAVI.
骨桥蛋白（OPN）是一种细胞外基质蛋白，在心肌重塑中发挥着不可或缺的作用，并且此前已被证明是心血管疾病中有价值的生物标志物。由于严重的有症状主动脉瓣狭窄（AS）会导致向心性心肌肥厚，我们推测OPN表达在接受经导管主动脉瓣植入术（TAVI）的患者中可能具有预后价值。
我们前瞻性纳入了2011年2月至2013年12月期间接受TAVI的217例患者，中位随访时间为349天。20名年龄范围相同且无结构性心脏病的健康个体作为对照。分析的主要终点是生存时间。
与健康对照（386 ng/mL；四分位间距324.5 - 458）相比，严重主动脉瓣狭窄患者术前OPN水平中位数（675 ng/mL；四分位间距488.5 - 990.5 ng/mL）显著更高（p<0.001）。OPN值升高的患者在基线时6分钟步行试验表现下降、房性心律失常发生率增加且随访期间死亡风险增加（最高与最低OPN四分位数比较的风险比为2.2；95%置信区间1.3至3.5）。多因素Cox回归分析表明，与N端脑钠肽前体相比，OPN能进一步改善对不良预后的预测。
基线时OPN水平与严重的有症状AS且接受TAVI的患者的不良结局相关。
