Boxhammer Elke, Hecht Stefan, Kaufmann Reinhard, Kammler Jürgen, Kellermair Jörg, Reiter Christian, Akbari Kaveh, Blessberger Hermann, Steinwender Clemens, Lichtenauer Michael, Hoppe Uta C, Hergan Klaus, Scharinger Bernhard
Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
Diagnostics (Basel). 2023 Jan 18;13(3):358. doi: 10.3390/diagnostics13030358.
Both relevant aortic valve stenosis (AS) and aortic valve insufficiency significantly contribute to structural changes in the ascending aorta (AA) and thus to its dilatation. In patients with severe AS undergoing transcatheter aortic valve replacement (TAVR), survival data regarding aortic changes and laboratory biomarker analyses are scarce.
A total of 179 patients with severe AS and an available computed tomography were included in this retrospective study. AA was measured, and dilatation was defined as a diameter ≥ 40 mm. Thirty-two patients had dilatation of the AA. A further 32 patients from the present population with a normal AA were matched to the aortic dilatation group with respect to gender, age, body mass index and body surface area, and the resulting study groups were compared with each other. In addition to echocardiographic and clinical characteristics, the expression of cardiovascular biomarkers such as brain natriuretic peptide (BNP), soluble suppression of tumorigenicity-2 (sST2), growth/differentiation of factor-15 (GDF-15), heart-type fatty-acid binding protein (H-FABP), insulin-like growth factor binding protein 2 (IGF-BP2) and soluble urokinase-type plasminogen activator receptor (suPAR) was analyzed. Kaplan-Meier curves for short- and long-term survival were obtained, and Pearson's and Spearman's correlations were calculated to identify the predictors between the diameter of the AA and clinical parameters.
A total of 19% of the total cohort had dilatation of the AA. The study group with an AA diameter ≥ 40 mm showed a significantly low comorbidity with respect to diabetes mellitus in contrast to the comparison cohort with an AA diameter < 40 mm ( = 0.010). This result continued in the correlation analyses performed, as the presence of diabetes mellitus correlated negatively not only with the diameter of the AA (r = -0.404; = 0.001) but also with the presence of aortic dilatation (r = -0.320; = 0.010). In addition, the presence of AA dilatation after TAVR was shown to have no differences in terms of patient survival at 1, 3 and 5 years. There were no relevant differences in the cardiovascular biomarkers studied between the patients with dilated and normal AAs.
The presence of AA dilatation before successful TAVR was not associated with a survival disadvantage at the respective follow-up intervals of 1, 3 and 5 years. Diabetes mellitus in general seemed to have a protective effect against the development of AA dilatation or aneurysm in patients with severe AS.
相关的主动脉瓣狭窄（AS）和主动脉瓣关闭不全均显著导致升主动脉（AA）的结构变化，进而导致其扩张。在接受经导管主动脉瓣置换术（TAVR）的重度AS患者中，关于主动脉变化的生存数据和实验室生物标志物分析较少。
本回顾性研究纳入了179例患有重度AS且有可用计算机断层扫描的患者。测量AA，将扩张定义为直径≥40mm。32例患者存在AA扩张。从本研究人群中另外选取32例AA正常的患者，在性别、年龄、体重指数和体表面积方面与主动脉扩张组进行匹配，并将所得研究组相互比较。除了超声心动图和临床特征外，还分析了心血管生物标志物如脑钠肽（BNP）、可溶性肿瘤抑制因子2（sST2）、生长/分化因子15（GDF-15）、心型脂肪酸结合蛋白（H-FABP）、胰岛素样生长因子结合蛋白2（IGF-BP2）和可溶性尿激酶型纤溶酶原激活剂受体（suPAR）的表达。获得短期和长期生存的Kaplan-Meier曲线，并计算Pearson相关性和Spearman相关性，以确定AA直径与临床参数之间的预测因素。
整个队列中共有19%的患者存在AA扩张。与AA直径<40mm的比较队列相比，AA直径≥40mm的研究组在糖尿病方面的合并症显著较低（P = 0.010）。在进行的相关性分析中，这一结果仍然成立，因为糖尿病的存在不仅与AA直径呈负相关（r = -0.404；P = 0.001），而且与主动脉扩张的存在也呈负相关（r = -0.320；P = 0.010）。此外，TAVR后AA扩张的存在在1、3和5年的患者生存率方面没有差异。AA扩张患者和正常AA患者之间研究的心血管生物标志物没有相关差异。
在成功进行TAVR之前，AA扩张的存在在1、3和5年的各自随访间隔中与生存劣势无关。总体而言，糖尿病似乎对重度AS患者AA扩张或动脉瘤的发生具有保护作用。
