Academic Editor: Giuseppe Santarpino
Background: Prediction of long-term mortality in patients with severe
symptomatic aortic valve stenosis undergoing transcatheter aortic valve
implantation (TAVI) is still challenging but of great impact with respect to the
selection of treatment strategy. Whereas most of the established scores address
perioperative risk and/or short-term mortality, the aim of our current study was
the integrative investigation of a multitude of patients’ characteristics
including novel biomarkers of cardiovascular remodeling with respect to their
value for the prediction of long-term mortality. Methods: In a first
subset of patients (n = 122, identification group) a wide range of baseline
characteristics were assigned to three clusters with 4 to 10 items each
(classical clinical parameters; risk assessment scores; novel biomarkers of
cardiovascular remodeling) and tested with respect to their predictive value for
one-year mortality. Thereby, a sum-score system (Jena Mortality Score, JMS) was
defined and tested in a larger collective of TAVI patients (n = 295, validation
group) with respect to one- and two-year mortality prediction. Results:
In the identification cohort, binary logistic regression analysis, with one-year
mortality as dependent variable and the items per cluster as cofounders, revealed
atrial fibrillation (Afib; odds ratio [OR] 7.583, 95% confidence interval [95% CI]: 2.051–28.040, p = 0.002), clinical frailty
scale (CFS; OR 2.258, 95% CI: 1.262–4.039, p = 0.006) and Tissue-Inhibitor
of Metalloproeinase-1 (TIMP-1; OR 1.006, 95% CI: 1.001–1.011, p = 0.019) as
independent predictors of one-year mortality. These 3 parameters were integrated
into a simplified sum-score as follows: presence of Afib (no = 0, yes = 1);
dichotomized CFS (1 to 4 = 0; 5 to 9 = 1); TIMP-1 range (cut-off value 187.2
ng/mL; below = 0, above = 1). The resulting sum-score (JMS) ranged from 0 to 3.
By binary logistic regression analysis in the validation cohort with one- and
two-year mortality as dependent variable and Society of Thoracic Surgeons (STS)
score (STS), staging of extra-valvular cardiac damage (stage), presence of high
gradient aortic stenosis (HGAS), EQ visual analogue scale score (EQ-VAS) and JMS
as cofounders, besides STS score, only JMS could be proven to serve as
independent predictor of both, one-year (OR 1.684, 95% CI: 1.094–2.592, p =
0.018) and two-year (OR 1.711, 95% CI: 1.136–2.576, p = 0.010) mortality.
After dichotomization of patients into a low-risk and a high-risk group according
to JMS, Kaplan-Meier survival analysis displayed a significant survival benefit
for the low-risk group after one and two years (p