经导管主动脉瓣植入术中根据糖类抗原125水平评估半乳糖凝集素-3的差异预后价值
Differential Prognostic Value of Galectin-3 According to Carbohydrate Antigen 125 Levels in Transcatheter Aortic Valve Implantation.
作者信息
Rheude Tobias, Pellegrini Costanza, Núñez Julio, Joner Michael, Trenkwalder Teresa, Mayr N Patrick, Holdenrieder Stefan, Bodi Vicent, Koenig Wolfgang, Kasel Albert M, Schunkert Heribert, Kastrati Adnan, Hengstenberg Christian, Husser Oliver
机构信息
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain.
出版信息
Rev Esp Cardiol (Engl Ed). 2019 Nov;72(11):907-915. doi: 10.1016/j.rec.2018.09.006. Epub 2018 Oct 25.
INTRODUCTION AND OBJECTIVES
Galectin-3 (Gal-3) and carbohydrate antigen 125 (CA125) have been associated with adverse outcomes after transcatheter aortic valve implantation (TAVI). Experimental data have suggested a potential molecular interaction. Therefore, we assessed the association of Gal-3 and CA125 with prognosis after TAVI.
METHODS
A total of 439 patients were enrolled. The primary endpoint was a composite of all-cause mortality or readmission for worsening heart failure after TAVI.
RESULTS
The primary endpoint occurred in 16.4%. Gal-3 was dichotomized at ≥ 8.71 ng/mL into elevated and not elevated. Gal-3 was elevated in 31.9% and was associated with a higher risk of the primary endpoint (25% vs 12.4%, HR, 2.26; P<.001). After multivariable adjustment, the association of elevated Gal-3 with the primary endpoint was borderline significant (HR, 1.59; P=.068). CA125 was dichotomized at ≥ 18.4 U/mL, accordingly. CA125 was elevated in 51.9% and was also associated with a higher risk of the primary endpoint (25.4% vs 6.6%, HR, 4.20; P<.001). After multivariable adjustment, elevated CA125 (HR, 2.83; P=.001) remained independently associated with the primary endpoint. A differential prognostic effect of Gal-3 was found across CA125 status (P for interaction=.048). Elevated Gal-3 was associated with a higher risk of the primary endpoint when CA125 was elevated (38.8% vs 18.2%, HR, 2.02; P=.015) but lacked significance when CA125 was not elevated (6.6% vs 6.7%, HR, 1.16; P=.981).
CONCLUSIONS
In patients undergoing TAVI, Gal-3 predicted adverse clinical outcomes only when CA125 was elevated.
引言与目的
半乳糖凝集素-3（Gal-3）和糖类抗原125（CA125）与经导管主动脉瓣植入术（TAVI）后的不良预后相关。实验数据提示了一种潜在的分子相互作用。因此，我们评估了Gal-3和CA125与TAVI后预后的关联。
方法
共纳入439例患者。主要终点为TAVI后全因死亡或因心力衰竭恶化再次入院的复合终点。
结果
主要终点发生率为16.4%。Gal-3以≥8.71 ng/mL分为升高和未升高两组。Gal-3升高的患者占31.9%，且与主要终点风险较高相关（25%对12.4%，HR为2.26；P<0.001）。多变量调整后，Gal-3升高与主要终点的关联接近显著（HR为1.59；P=0.068）。CA125以≥18.4 U/mL分为升高和未升高两组。CA125升高的患者占51.9%，也与主要终点风险较高相关（25.4%对6.6%，HR为4.20；P<0.001）。多变量调整后，CA125升高（HR为2.83；P=0.001）仍与主要终点独立相关。在CA125不同状态下发现Gal-3有不同的预后效应（交互作用P=0.048）。当CA125升高时，Gal-3升高与主要终点风险较高相关（38.8%对18.2%，HR为2.02；P=0.015），但当CA125未升高时无显著意义（6.6%对6.7%，HR为1.16；P=0.981）。
结论
在接受TAVI的患者中，Gal-3仅在CA125升高时才预测不良临床结局。
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