Beschreibung:
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<jats:bold>Background:</jats:bold>
Osteopontin (OPN) is an extracellular matrix protein that plays an integral role in myocardial remodeling and was previously shown as an important emerging biomarker in risk evaluation of cardiovascular disease. However, its prognostic value in patients with pressure overload of the left ventricular, caused by symptomatic severe aortic valve stenosis, undergoing transcatheter aortic valve implantation (TAVI) remains unclear.
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<jats:bold>Methods:</jats:bold>
N=217 patients undergoing TAVI (using balloon-expandable Edwards Sapien XT prostheses) were included prospectively over a continuous period from Feb. 2011 until Dec. 2013. For all patients a complete clinical data set including biomarkers (OPN and NTproBNP), basic clinical assessment and echocardiography before and 7 days after TAVI was obtained. The primary endpoint was survival time.
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<jats:p>During median follow-up of 349d (Q1, Q3: 106-659.5d), a total of 66 deaths occurred, 30d mortality was 6.9%. Mean age was 81.8 years (± 6.03 y) and 55.8 % of the patients were female. Mean log. Euroscore was 25.4% (± 17.2%) and mean STS Score was 6.2% (± 3.8%).</jats:p>
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<jats:bold>Results:</jats:bold>
Median preprocedurale OPN values were significantly elevated in patients with severe aortic valve stenosis compared to healthy controls (675 ng/ml, Q1,Q3: 488.5-990.5 ng/ml vs. 386 ng/ml, Q1, Q3: 324.5 - 458.0, p<0.001). Increased OPN levels before TAVI (upper quartile compared to lower three quartiles) revealed a HR of 2.151 (CI 1.31-3.531, p=0.002) for reduced survival.
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<jats:p>Multivariate Cox regression analysis including NTproBNP, postprocedural aortic regurgitation, atrial fibrillation, clinical risk scores and preprocedural left ventricular function (EF) demonstrates that OPN is even superior to NTproBNP and preprocedural EF in predicting adverse prognosis, showing a HR of 1.826 (CI 1.096-3.044, p=0.021).</jats:p>
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<jats:bold>Conclusions:</jats:bold>
Elevated OPN levels predict adverse outcome in patients with severe aortic stenosis undergoing TAVI. OPN is superior to the established biomarker NTproBNP in risk stratification of patients undergoing TAVI.
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