Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium.
Department of Cardiology, ZorgSaam Hospital, Terneuzen, The Netherlands.
Acta Cardiol. 2024 Apr;79(2):114-122. doi: 10.1080/00015385.2023.2223012. Epub 2024 Feb 20.
Transcatheter aortic valve implantation (TAVI) is a suitable treatment for patients with severe aortic stenosis and severely increased operative risk. There is need for a better preoperative risk assessment for TAVI candidates.
To determine whether Tumour necrosis factor-alfa (TNFα) is an independent predictor of survival 500 days after TAVI.
Sixty patients undergoing TAVI were enrolled in the study. TNFα was determined. The CT measured low-density muscle fraction (LDM%) of the psoas muscle was determined. Operative risk assessment by Logistic EuroSCORE, EuroSCORE II, and STS score was performed. Frailty scores (FRAIL scale and Barthel index) were determined.
Mean age was 81.01 ± 7.54 years. Twenty-six (43.3%) of the patients were males. In the univariable analyses, FRAIL scale and Barthel index were no predictors of survival after TAVI. In the multivariable analysis, including EuroSCORE II, LDM% and TNFα serum concentration, TNFα serum level was an independent predictor of survival 500 days after TAVI (HR: 3.167; 95%: 1.279-7.842; = 0.013). The multivariable analysis, including TNFα as a categorical variable, showed that compared to patients in the conjugated first and second TNFα serum level tertile, patients in the third tertile had a hazard ratio (HR) of 10.606 (95%CI: 1.203 - 93.467) ( = 0.033).
TNFα is an incremental independent predictor of long-term survival after TAVI.
经导管主动脉瓣植入术（TAVI）是治疗严重主动脉瓣狭窄和手术风险极高的患者的一种合适方法。需要对 TAVI 候选者进行更好的术前风险评估。
确定肿瘤坏死因子-α（TNFα）是否是 TAVI 后 500 天生存的独立预测因子。
纳入 60 例接受 TAVI 的患者进行研究。测定 TNFα。通过 CT 测定腰大肌的低密度肌肉分数（LDM%）。通过 Logistic EuroSCORE、EuroSCORE II 和 STS 评分进行手术风险评估。测定虚弱评分（FRAIL 量表和巴氏量表）。
平均年龄为 81.01±7.54 岁。26 名（43.3%）患者为男性。在单变量分析中，FRAIL 量表和巴氏量表不是 TAVI 后生存的预测因子。在多变量分析中，包括 EuroSCORE II、LDM%和 TNFα 血清浓度，TNFα 血清水平是 TAVI 后 500 天生存的独立预测因子（HR：3.167；95%CI：1.279-7.842；P=0.013）。多变量分析中，将 TNFα 作为分类变量，与处于 TNFα 血清水平第一和第二 tertile 的患者相比，处于第三 tertile 的患者的危险比（HR）为 10.606（95%CI：1.203-93.467）（P=0.033）。
TNFα 是 TAVI 后长期生存的增量独立预测因子。
