TY - JOUR
T1 - Multiorgan Dysfunction and its Association With Congestion and Outcome in Aortic Stenosis Treated With TAVI
AU - Halavina, Kseniya
AU - Koschatko, Sophia
AU - Jantsch, Charlotte
AU - Autherith, Maximilian
AU - Petric, Fabian
AU - Röckel, Anna
AU - Mascherbauer, Katharina
AU - Koschutnik, Matthias
AU - Donà, Carolina
AU - Heitzinger, Gregor
AU - Dannenberg, Varius
AU - Hauptmann, Laurenz
AU - Andreas, Martin
AU - Demirel, Caglayan
AU - Hemetsberger, Rayyan
AU - Kammerlander, Andreas A
AU - Hengstenberg, Christian
AU - Mascherbauer, Julia
AU - Bartko, Philipp E
AU - Nitsche, Christian
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2025/2
Y1 - 2025/2
N2 - BACKGROUND: 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.OBJECTIVES: 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).METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.
AB - BACKGROUND: 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.OBJECTIVES: 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).METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.
UR - http://www.scopus.com/inward/record.url?scp=85214293703&partnerID=8YFLogxK
U2 - 10.1016/j.jacadv.2024.101544
DO - 10.1016/j.jacadv.2024.101544
M3 - Journal article
C2 - 39886314
SN - 2772-963X
VL - 4
SP - 101544
JO - JACC: Advances
JF - JACC: Advances
IS - 2
M1 - 101544
ER -