Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
J Clin Lab Anal. 2021 Nov;35(11):e23977. doi: 10.1002/jcla.23977. Epub 2021 Sep 25.
Systemic inflammation has been identified as a major cardiovascular risk factor in patients undergoing transcatheter aortic valve replacement (TAVR), yet currently, it is not adequately portrayed in scores for pre-interventional risk assessment. The aim of this study was to investigate the predictive ability of TNF-α in TAVR.
A total of 431 patients undergoing transfemoral TAVR were enrolled in this study. Blood samples were drawn prior to intervention, 24 h post-intervention, 4, 5, and 7 days post-intervention, and 1, 3, and 6 months post-TAVR.
In a univariate Cox proportional hazard analysis, plasma concentrations of TNF-α after 24 h and after 5 days were associated with mortality after 12 months (after 24 h: HR 1.002 (1.000-1.004), p = 0.028; after 5d: HR 1.003 (1.001-1.005), p = 0.013). This association remained significant even after correction for confounders in a multivariate Cox regression analysis. Additionally, cut-offs were calculated. Patients above the cut-off for TNF-α after 5d had a significantly worse 12-month mortality than patients below the cut-off (18.8% vs. 2.8%, p = 0.046).
Plasma levels of TNF-α after 24 h and 5 days were independently associated with 12-month mortality in patients undergoing TAVR. Thus, TNF-α could represent a novel biomarker for enhanced risk stratification in these patients.
系统性炎症已被确定为行经导管主动脉瓣置换术（TAVR）患者的主要心血管风险因素，但目前在术前风险评估评分中尚未充分体现。本研究旨在探讨 TNF-α 在 TAVR 中的预测能力。
本研究共纳入 431 例行经股动脉 TAVR 的患者。在介入前、介入后 24 小时、4 天、5 天、7 天、1 个月、3 个月和 6 个月时抽取血样。
在单变量 Cox 比例风险分析中，介入后 24 小时和 5 天后的 TNF-α 血浆浓度与 12 个月后的死亡率相关（介入后 24 小时：HR 1.002（1.000-1.004），p=0.028；介入后 5 天：HR 1.003（1.001-1.005），p=0.013）。即使在多变量 Cox 回归分析中校正混杂因素后，这种相关性仍然显著。此外，还计算了截断值。TNF-α 5 天后高于截断值的患者 12 个月死亡率明显高于低于截断值的患者（18.8%比 2.8%，p=0.046）。
TAVR 患者介入后 24 小时和 5 天的 TNF-α 血浆水平与 12 个月死亡率独立相关。因此，TNF-α 可能成为这些患者风险分层的新生物标志物。
