University Department for Cardiac Surgery, HELIOS Leipzig Heart Center, Leipzig, Germany.
University Department for Cardiac Surgery, HELIOS Leipzig Heart Center, Leipzig, Germany.
J Cardiol. 2020 Aug;76(2):154-162. doi: 10.1016/j.jjcc.2020.02.019. Epub 2020 Apr 7.
The prognostic value of biomarkers in aortic stenosis (AS) remains understudied. We investigated whether a combination of biomarkers related to cardiovascular stress, inflammation, and damage is associated with mortality in patients with severe AS undergoing surgical aortic valve replacement (SAVR).
From a prospective registry of patients with severe AS referred for SAVR, 499 participants (mean age, 68 ± 8.5 years; 292 male) with available preoperative echocardiograms and biomarker data were included. Preoperative concentrations of NT-pro-B-type natriuretic peptide, high-sensitivity cardiac troponin T, and C-reactive protein were dichotomized as high or low, according to calculated cut-off values.
The mean follow-up time was 775 ± 410 days; 25 patients died. Only patients with elevated levels of all three biomarkers (n = 55) showed increased mortality [hazard ratio (HR), 7.26; 95% confidence interval (CI), 2.52-20.93; p < 0.001; reference group, no elevated biomarkers, n = 159]. Patients with elevated levels of the three biomarkers had higher 3-year all-cause mortality (24% vs. 4.5%); this remained true after multivariable adjustment (HR, 4.08; 95% CI, 1.87-8.87; p < 0.001). Patients with EuroSCOREs (logES) >3.0% tended to exhibit a higher risk of all-cause mortality (HR, 2.19; 95% CI, 0.98-4.87; p = 0.055); the mortality rate was 12-fold higher when logES >3 was combined with the three elevated biomarkers. This combination also showed a net reclassification improvement of 33% and significant likelihood-ratio test results.
A multiple biomarker approach might be useful for predicting postoperative mid-term mortality in patients with severe AS undergoing SAVR. Further large-scale prospective validation should be performed.
生物标志物在主动脉瓣狭窄（AS）中的预后价值仍有待研究。我们研究了在接受主动脉瓣置换术（SAVR）的严重 AS 患者中，与心血管应激、炎症和损伤相关的生物标志物组合是否与死亡率相关。
从一个接受 SAVR 的严重 AS 患者的前瞻性登记处，纳入了 499 名有术前超声心动图和生物标志物数据的参与者（平均年龄 68±8.5 岁，292 名男性）。根据计算的截断值，将 NT-pro-B 型利钠肽、高敏心肌肌钙蛋白 T 和 C 反应蛋白的术前浓度分为高或低。
平均随访时间为 775±410 天；25 名患者死亡。只有三种生物标志物水平均升高的患者（n=55）死亡率增加[风险比（HR），7.26；95%置信区间（CI），2.52-20.93；p<0.001；参考组，无升高的生物标志物，n=159]。三种生物标志物水平升高的患者 3 年全因死亡率更高（24% vs. 4.5%）；这在多变量调整后仍然成立（HR，4.08；95%CI，1.87-8.87；p<0.001）。EuroSCOREs（logES）>3.0%的患者倾向于表现出更高的全因死亡率风险（HR，2.19；95%CI，0.98-4.87；p=0.055）；当 logES>3 与三种升高的生物标志物结合时，死亡率增加了 12 倍。这种组合还显示了 33%的净重新分类改善和显著的似然比检验结果。
在接受 SAVR 的严重 AS 患者中，多种生物标志物方法可能有助于预测术后中期死亡率。应进一步进行大规模前瞻性验证。
