Prognostic Utility of Biomarkers in Predicting of One- Year Outcomes in Patients with Aortic Stenosis Treated with Transcatheter or Surgical Aortic Valve Implantation

Authors

PAŘENICA Jiří NĚMEC Petr TOMANDL Josef ONDRÁŠEK Jiří PÁVKOVÁ GOLDBERGOVÁ Monika TŘETINA Martin JARKOVSKÝ Jiří LITTNEROVÁ Simona POLOCZEK Martin POKORNÝ Petr ŠPINAR Jindřich ČERMÁKOVÁ Zdeňka MIKLÍK Roman MALÍK Petr PEŠ Ondřej LIPKOVÁ Jolana TOMANDLOVÁ Marie KALA Petr

Year of publication 2012
Type Article in Periodical
Magazine / Source PloS ONE
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1371/journal.pone.0048851
Field Cardiovascular diseases incl. cardiosurgery
Keywords Aortic Stenosis; Transcatheter; Aortic Valve Implantation; Outcome
Description Objectives: The aim of the work was to find biomarkers identifying patients at high risk of adverse clinical outcomes after TAVI and SAVR in addition to currently used predictive model (EuroSCORE). Methods: The multi-biomarker sub-study included 42 consecutive high-risk patients (average age 82.0 years; logistic EuroSCORE 21.0%) allocated to TAVI transfemoral and transapical using the Edwards-Sapien valve (n = 29), or SAVR with the Edwards Perimount bioprosthesis (n = 13). Standardized endpoints were prospectively followed during the 12-month follow-up. Results: The clinical outcomes after both TAVI and SAVR were comparable. Malondialdehyde served as the best predictor of a combined endpoint at 1 year with AUC (ROC analysis) = 0.872 for TAVI group, resp. 0.765 (p,0.05) for both TAVI and SAVR groups. Increased levels of MDA, matrix metalloproteinase 2, tissue inhibitor of metalloproteinase (TIMP1), ferritin-reducing ability of plasma, homocysteine, cysteine and 8-hydroxy-2-deoxyguanosine were all predictors of the occurrence of combined safety endpoints at 30 days (AUC 0.750–0.948; p,0.05 for all). The addition of MDA to a currently used clinical model (EuroSCORE) significantly improved prediction of a combined safety endpoint at 30 days and a combined endpoint (0–365 days) by the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) (p,0.05). Cystatin C, glutathione, cysteinylglycine, asymmetric dimethylarginine, nitrite/nitrate and MMP9 did not prove to be significant. Total of 14.3% died during 1-year follow-up. Conclusion: We identified malondialdehyde, a marker of oxidative stress, as the most promising predictor of adverse outcomes during the 30-day and 1-year follow-up in high-risk patients with symptomatic, severe aortic stenosis treated with TAVI. The development of a clinical ‘‘TAVIscore’’ would be highly appreciated. Such dedicated scoring system would enable further testing of adjunctive value of various biomarkers.
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