中段肾上腺髓质素和生长分化因子15在经股动脉导管主动脉瓣植入术患者中的预后效用

Prognostic utility of mid-regional pro-adrenomedullin and growth differentiation factor 15 in patients undergoing transfemoral transcatheter aortic valve implantation.

作者信息

Piayda Kerstin, Keranov Stanislav, Schulz Luisa, Arsalan Mani, Liebetrau Christoph, Kim Won-Keun, Hofmann Felsix J, Bauer Pascal, Voss Sandra, Troidl Christian, Sossalla Samuel T, Hamm Christian W, Nef Holger M, Dörr Oliver

机构信息

Department of Cardiology, Justus-Liebig-University Giessen, Medical Clinic I, Giessen, Germany.

Heart and Vascular Center Bad Segeberg, Cardiology and Angiology, Segeberger Kliniken GmbH, Bad Segeberg, Germany.

出版信息

Clin Res Cardiol. 2024 Oct 25. doi: 10.1007/s00392-024-02560-w.

DOI:10.1007/s00392-024-02560-w

PMID:39453458

Abstract

BACKGROUND

Risk prediction in patients with severe, symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) remains an unsolved issue. In addition to classical risk scoring systems, novel circulating biomarkers like mid-regional pro-adrenomedullin (MR-proADM) and growth differentiation factor 15 (GDF-15) may be of value in assessing risk.

METHODS

Consecutive patients undergoing elective transfemoral TAVI were included in this prospective observational study. Baseline information, imaging findings, blood samples, and clinical outcomes were collected. Blood levels of the classical biomarkers interleukin-6 (IL-6) and high-sensitivity C-reactive peptide (hsCRP) and of the novel biomarkers MR-proADM and GDF-15 were measured and their predictive utility for mortality assessed.

RESULTS

The study cohort consisted of 92 patients undergoing TAVI. The median age was 80.7 years [IQR 77.2;83.3], and 48 (52.2%) were male. Analysis of the area under the curve (AUC) of the receiver-operating characteristics showed that the hsCRP levels discriminated poorly (AUC 0.66, 95% CI [0.52;0.8], p = 0.027), whereas all other biomarkers reached a higher level of discrimination (IL-6: AUC 0.76, 95% CI [0.66;0.86], p < 0.001; MR-proADM: AUC 0.73, 95% CI [0.61;0.85], p = 0.002; GDF-15: AUC 0.73, 95% CI [0.61;0.85], p = 0.002). Kaplan-Meier analysis in conjunction with Youden J-statistics yielded the optimal cutoff points for each biomarker to predict survival: IL-6 4.65 pg/mL, hsCRP 12.9 mg/L, MR-proADM 1.02 nmol/L, and GDF-15 2400.1 pg/mL.

CONCLUSION

Novel circulating biomarkers like MR-proADM and GDF-15 may provide additional value in predicting survival after TAVI.

摘要

背景

对于接受经导管主动脉瓣植入术（TAVI）的重度症状性主动脉瓣狭窄（AS）患者，风险预测仍是一个未解决的问题。除了经典的风险评分系统外，新型循环生物标志物如中段肾上腺髓质素原（MR-proADM）和生长分化因子15（GDF-15）在评估风险方面可能具有价值。

方法

本前瞻性观察性研究纳入了连续接受择期经股动脉TAVI的患者。收集基线信息、影像学检查结果、血液样本和临床结局。检测经典生物标志物白细胞介素-6（IL-6）和高敏C反应蛋白（hsCRP）以及新型生物标志物MR-proADM和GDF-15的血液水平，并评估它们对死亡率的预测效用。

结果

研究队列包括92例接受TAVI的患者。中位年龄为80.7岁[四分位间距77.2；83.3]，48例（52.2%）为男性。对受试者工作特征曲线下面积（AUC）的分析表明，hsCRP水平的区分能力较差（AUC 0.66，95%可信区间[0.52；0.8]，p = 0.027），而所有其他生物标志物的区分水平更高（IL-6：AUC 0.76，95%可信区间[0.66；0.86]，p < 0.001；MR-proADM：AUC 0.73，95%可信区间[0.61；0.85]，p = 0.002；GDF-15：AUC 0.73，95%可信区间[0.61；0.85]，p = 0.002）。Kaplan-Meier分析结合约登J统计量得出每个生物标志物预测生存的最佳截断点：IL-6为4.65 pg/mL，hsCRP为12.9 mg/L，MR-proADM为1.02 nmol/L，GDF-15为2400.1 pg/mL。