Abstract
Background: Severe aortic valve stenosis (AS) is associated with pulmonary hypertension (PH) and has been shown to limit patient survival. Soluble suppression of tumorigenicity-2 (sST2) is a cardiovascular biomarker that has proven to be an important prognostic marker for survival in patients undergoing transcatheter aortic valve replacement (TAVR). The aim of this study was to assess the importance of the sST2 biomarker for risk stratification in patients with severe AS in presence or absence of PH. Methods: In 260 patients with severe AS undergoing TAVR procedure, sST2 serum level concentrations were analyzed. Right heart catheter measurements were performed in 152 patients, with no PH detection in 43 patients and with PH detection in 109 patients. Correlation analyses according to Spearman, AUROC analyses and Kaplan–Meier curves were calculated. Results: Patients with severe AS and PH showed significantly higher serum sST2 concentrations (p = 0.006). The sST2 cut-off value for non-PH patients regarding 1-year survival yielded 5521.15 pg/mL, whereas the cut-off value of PH patients was at a considerably higher level of 10,268.78 pg/mL. A cut-off value of 6990.12 pg/mL was related with a significant probability of PH presence. Survival curves showed that patients with severe AS and PH not only had higher 1-year mortality, but also that increased levels of sST2 plasma concentration were associated with earlier death. Conclusion: sST2 definitely has the potential to provide information about the presence of PH in patients with severe AS, in a noninvasive way.
Highlights
After mitral valve regurgitation, aortic valve stenosis (AS) constitutes the second most frequent valvular disorder worldwide, but represents the most common disorder requiring medical treatment, with a prevalence of 3.4% in patients >75 years [1].In addition to surgical aortic valve replacement, transcatheter aortic valve replacement (TAVR) has been available since 2002 as a minimally invasive procedure that allows high-risk patients with severe pre-existing comorbidities, high frailty score, and limited anesthetic capacity to undergo a procedure that is very safe and less risky [2]
This analysis identified a suppression of tumorigenicity-2 (sST2) plasma level of 5521.15 pg/mL as an optimal cut-off value concerning 1-year mortality for the non-pulmonary hypertension (PH) group (AUC 0.794; 95%confidence interval (CI) 0.634–0.954; p = 0.015; Youden index (YI) 0.52; sensitivity 0.86; specificity 0.67) (Figure 3A), whereas the cut off value of the PH group was at a considerably higher sST2 plasma level of 10,268.78 pg/mL
An mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg was used according to ESC guidelines
Summary
In addition to surgical aortic valve replacement, TAVR has been available since 2002 as a minimally invasive procedure that allows high-risk patients with severe pre-existing comorbidities, high frailty score, and limited anesthetic capacity to undergo a procedure that is very safe and less risky [2]. Severe aortic valve stenosis (AS) is associated with pulmonary hypertension (PH) and has been shown to limit patient survival. Is a cardiovascular biomarker that has proven to be an important prognostic marker for survival in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: In 260 patients with severe AS undergoing TAVR procedure, sST2 serum level concentrations were analyzed. The sST2 cut-off value for non-PH patients regarding 1-year survival yielded 5521.15 pg/mL, whereas the cut-off value of PH patients was at a considerably higher level of
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