Baran Jakub, Niewiara Łukasz, Podolec Jakub, Siedliński Mateusz, Józefczuk Ewelina, Bernacik Anna, Badacz Rafał, Przewłocki Tadeusz, Pieniążek Piotr, Żmudka Krzysztof, Legutko Jacek, Kabłak-Ziembicka Anna
Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland.
Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Św. Anny 12, 31-008 Krakow, Poland.
J Cardiovasc Dev Dis. 2022 Jun 17;9(6):193. doi: 10.3390/jcdd9060193.
Background: Although degenerative aortic valve stenosis (DAS) is the most prevalent growth-up congestive heart valve disease, still little known about relationships between DAS severity, vascular stiffness (VS), echocardiographic parameters, and serum biomarkers in patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR). The objective of this study was to identify biomarkers associated with DAS severity, and those that are associated with cardiovascular death (CVD) and episodes of chronic heart failure (CHF) exacerbation. Methods: A total of 137 patients with initially moderate-to-severe DAS were prospectively evaluated for the relationship between DAS severity, baseline VS, and serum biomarkers (uPAR, GDF-15, Gal-3, IL-6Rα, ET-1, PCSK9, RANTES/CCL5, NT-proBNP, and hs-TnT), and were followed-up for 48 months. The prognostic significance of each variable for CVD and CHF risk was measured by hazard ratio of risk (HR), which was calculated by Cox’s proportional hazard model. Results: DAS severity showed correlations with IL-6Rα (r = 0.306, p < 0.001), uPAR (r = 0.184, p = 0.032), and NT-proBNP (r = −0.389, p < 0.001). Levels of ET-1 and Gal-3 were strongly correlated with VS parameters (r = 0.674, p < 0.001; r = 0.724, p < 0.001). Out of 137 patients, 20 were referred to TAVR, 88 to SAVR, and 29 to OMT. In TAVR patients, the highest levels of ET-1, Gal-3, and VS were found as compared to other patients. The highest incidence of CVD was observed in patients who underwent TAVR (35%), compared to SAVR (8%) and OMT (10.3%) (p = 0.004). In a multivariate analysis, ET-1 occurred predictive of CVD risk (HR 25.1, p = 0.047), while Gal-3 > 11.5 ng/mL increased the risk of CHF exacerbation episodes requiring hospital admission by 12%. Conclusions: Our study indicated that ET-1 and Gal-3 levels may be associated with the outcomes in patients with DAS.
尽管退行性主动脉瓣狭窄（DAS）是最常见的成人充血性心脏瓣膜病，但对于接受经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）的患者，DAS严重程度、血管僵硬度（VS）、超声心动图参数和血清生物标志物之间的关系仍知之甚少。本研究的目的是确定与DAS严重程度相关的生物标志物，以及与心血管死亡（CVD）和慢性心力衰竭（CHF）加重发作相关的生物标志物。方法：前瞻性评估137例初始为中重度DAS的患者，以研究DAS严重程度、基线VS和血清生物标志物（uPAR、GDF-15、Gal-3、IL-6Rα、ET-1、PCSK9、RANTES/CCL5、NT-proBNP和hs-TnT）之间的关系，并对其进行48个月的随访。通过风险比（HR）衡量每个变量对CVD和CHF风险的预后意义，HR由Cox比例风险模型计算得出。结果：DAS严重程度与IL-6Rα（r = 0.306，p < 0.001）、uPAR（r = 0.184，p = 0.032）和NT-proBNP（r = -0.389，p < 0.001）相关。ET-1和Gal-3水平与VS参数密切相关（r = 0.674，p < 0.001；r = 0.724，p < 0.001）。137例患者中，20例行TAVR，88例行SAVR，29例行药物治疗（OMT）。与其他患者相比，TAVR患者的ET-1、Gal-3和VS水平最高。TAVR患者的CVD发生率最高（35%），而SAVR患者为8%，OMT患者为10.3%（p = 0.004）。多因素分析显示，ET-1可预测CVD风险（HR 25.1，p = 0.047），而Gal-3>11.5 ng/mL使因CHF加重发作需住院治疗的风险增加12%。结论：我们的研究表明，ET-1和Gal-3水平可能与DAS患者的预后相关。
