Halavina Kseniya, Koschatko Sophia, Jantsch Charlotte, Autherith Maximilian, Petric Fabian, Röckel Anna, Mascherbauer Katharina, Koschutnik Matthias, Donà Carolina, Heitzinger Gregor, Dannenberg Varius, Hauptmann Laurenz, Andreas Martin, Demirel Caglayan, Hemetsberger Rayyan, Kammerlander Andreas A, Hengstenberg Christian, Mascherbauer Julia, Bartko Philipp E, Nitsche Christian
Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
JACC Adv. 2025 Jan 9;4(2):101544. doi: 10.1016/j.jacadv.2024.101544. eCollection 2025 Feb.
Degenerative severe aortic stenosis (AS) is treated by valve replacement to improve outcome. Despite diagnostic advancements, many AS patients are still diagnosed late with advanced heart failure.
The aim of the study was to assess multiorgan dysfunction in severe AS using blood biomarkers and their association with quantitative fluid levels and clinical outcomes after transcatheter aortic valve implantation (TAVI).
Consecutive AS patients undergoing TAVI received comprehensive preinterventional assessment with serum biomarker profiles reflecting organ dysfunction and quantitative fluid overload (FO) using bioelectrical impedance spectroscopy. FO by bioelectrical impedance spectroscopy was defined according to a previously established cut-off (≥1.0 L). Time to first heart failure hospitalization or death served as composite primary endpoint.
Among 880 patients (age 81 ± 7 years, 47% female), 41% had FO and 89% had biomarker abnormalities of at least one domain. Ascending fluid levels were independently associated with distorted biomarkers across domains of myocyte stress, hepatic dysfunction, renal dysfunction, inflammation, and anemia. After 2.4 ± 1.0 years of follow-up, 27% had reached the primary endpoint (29 heart failure hospitalization, 194 deaths, 13 both). Biomarkers across all domains were individually and independently associated with outcomes. In a multidomain approach, every affected extra-cardiac domain was associated with a 71% increase in event hazard (adjusted HR: 1.71; 95% CI: 1.39-2.11). Also, for each domain, the combination of distorted biomarkers and FO had the highest event risk.
Biomarker abnormalities are highly prevalent in severe AS, influenced by congestion, and associated with impaired prognosis post-TAVI. Multiorgan dysfunction faces a particularly dismal outcome.
退行性重度主动脉瓣狭窄（AS）通过瓣膜置换术进行治疗以改善预后。尽管诊断技术有所进步，但许多AS患者仍在晚期才被诊断出患有晚期心力衰竭。
本研究旨在使用血液生物标志物评估重度AS患者的多器官功能障碍，以及它们与经导管主动脉瓣植入术（TAVI）后定量液体水平和临床结局的关联。
连续接受TAVI的AS患者在介入治疗前接受了全面评估，包括反映器官功能障碍的血清生物标志物谱以及使用生物电阻抗光谱法进行定量液体超负荷（FO）评估。生物电阻抗光谱法测定的FO根据先前确定的临界值（≥1.0 L）进行定义。首次因心力衰竭住院或死亡的时间作为复合主要终点。
在880例患者（年龄81±7岁，47%为女性）中，41%存在FO，89%至少有一个领域的生物标志物异常。液体水平升高与心肌细胞应激、肝功能障碍、肾功能障碍、炎症和贫血等多个领域的生物标志物异常独立相关。经过2.4±1.0年的随访，27%的患者达到了主要终点（29例因心力衰竭住院，194例死亡，13例两者皆有）。所有领域的生物标志物均与结局单独且独立相关。在多领域分析中，每个受影响的心脏外领域与事件风险增加71%相关（调整后HR：1.71；95%CI：1.39-2.11）。此外，对于每个领域，生物标志物异常与FO的组合具有最高的事件风险。
生物标志物异常在重度AS中非常普遍，受充血影响，并与TAVI后的预后不良相关。多器官功能障碍面临特别严峻的结局。
