Osteopontin predicts clinical outcome in patients after treatment of severe aortic stenosis with transcatheter aortic valve implantation (TAVI).

OBJECTIVE

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).

METHODS

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.

RESULTS

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.

CONCLUSIONS

OPN levels at baseline are associated with adverse outcomes in patients with severe, symptomatic AS undergoing TAVI.