title: Prognostic utility of biomarkers in predicting of one-year outcomes in patients with aortic stenosis treated with transcatheter or surgical aortic valve implantation.
abstract: OBJECTIVE
  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).
  
  
  BACKGROUND
  There is limited data about the role of biomarkers in predicting prognosis, especially when TAVI is available.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University Hospital Brno, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
authors.forename: Petr
authors.initials: P
authors.lastname: Nemec
authors.forename: Josef
authors.initials: J
authors.lastname: Tomandl
authors.forename: Jiri
authors.initials: J
authors.lastname: Ondrasek
authors.forename: Monika
authors.initials: M
authors.lastname: Pavkova-Goldbergova
authors.forename: Martin
authors.initials: M
authors.lastname: Tretina
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
authors.forename: Simona
authors.initials: S
authors.lastname: Littnerova
authors.forename: Martin
authors.initials: M
authors.lastname: Poloczek
authors.forename: Petr
authors.initials: P
authors.lastname: Pokorny
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Cermakova
authors.forename: Roman
authors.initials: R
authors.lastname: Miklik
authors.forename: Petr
authors.initials: P
authors.lastname: Malik
authors.forename: Ondrej
authors.initials: O
authors.lastname: Pes
authors.forename: Jolana
authors.initials: J
authors.lastname: Lipkova
authors.forename: Marie
authors.initials: M
authors.lastname: Tomandlova
authors.forename: Petr
authors.initials: P
authors.lastname: Kala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001024:Aortic Valve Stenosis / Q000601:surgery* / Q000628:therapy*; D015415:Biomarkers / Q000378:metabolism*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D005109:Extracellular Matrix / Q000378:metabolism; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000378:metabolism; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D018384:Oxidative Stress; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D009569:Nitric Oxide; D008315:Malondialdehyde