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Prognostic value of lipid levels in short-term outcome after TAVI

Prognostischer Wert der Lipidspiegel beim Kurzzeitverlauf nach TAVI

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Abstract

Background

A satisfactory risk score specific to transaortic valve implantation (TAVI) procedure is strongly needed for accurate assessment of postprocedural mortality and outcome. The purpose of this study was to investigate the association between certain clinical and laboratory parameters, particularly serum cholesterol levels, and major adverse cardiac events in patients who underwent TAVI.

Method

We retrospectively analyzed 119 patients who underwent TAVI at our institution between 2008 and 2016. The independent relationship between clinical and laboratory parameters and major adverse cardiac and cerebrovascular events (MACCE) was analyzed by regression analysis.

Results

In all, 34 patients (28%) experienced MACCE during hospitalization and within 30 days of the procedure. Low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the MACCE(+) group compared with the MACCE(-) group (91.9 ± 38 vs. 110.8 ± 38.1 mg/dl, p = 0.01; 33.7 ± 7.3 vs. 38.1 ± 9.8 mg/dl, p = 0.02, respectively). In multivariate logistic regression analysis, age, white blood cell count (WBC), and lower levels of LDL-C and HDL-C were found to be independently correlated with MACCE in the study population. Receiver operating curve (ROC) analysis revealed that an LDL value higher than 71 mg/dl predicted MACCE with a sensitivity of 45.4% and a specificity of 91.8% (AUC: 0.814; p = 0.02).

Conclusion

This study suggests that lower serum LDL-C and HDL-C levels are independently associated with short-term MACCE in post-TAVI patients. Lower levels of LDL and HDL cholesterol may indicate a poor prognosis. Measurement of serum lipid levels might improve the preoperative risk assessment of potential TAVI candidates.

Zusammenfassung

Hintergrund

Ein zufriedenstellender Risikoscore, der sich speziell auf die transaortale Klappenimplantation (TAVI) bezieht, wird dringend benötigt, um postprozedural die Mortalität und den Verlauf genau ermitteln zu können. Ziel der vorliegenden Studie war es, den Zusammenhang zwischen bestimmten klinischen und Laborparametern, insbesondere Serumcholesterinwerten, und schweren unerwünschten kardialen Ereignissen bei Patienten nach TAVI zu untersuchen.

Methode

Die Autoren werteten retrospektiv die Daten von 119 Patienten aus, bei denen in der Klinik der Autoren zwischen 2008 und 2016 eine TAVI durchgeführt worden war. Die unabhängige Beziehung zwischen klinischen und Laborparametern und schweren unerwünschten kardialen und zerebrovaskulären Ereignissen (MACCE) wurde mit der Regressionsanalyse untersucht.

Ergebnisse

Insgesamt traten bei 34 Patienten (28 %) während des stationären Aufenthalts und innerhalb von 30 Tagen postoperativ MACCE auf. Die Spiegel für Low-Density-Lipoprotein-Cholesterin (LDL-C) und High-Density-Lipoprotein-Cholesterin (HDL-C) waren in der MACCE(+)-Gruppe signifikant niedriger als in der MACCE(-)-Gruppe (91,9 ± 38 vs. 110,8 ± 38,1 mg/dl; p = 0,01; bzw. 33,7 ± 7,3 vs. 38,1 ± 9,8 mg/dl; p = 0,02). In der multivariaten logistischen Regressionsanalyse stellte sich heraus, dass Alter, Zahl der weißen Blutkörperchen und niedrigere Spiegel für LDL-C und HDL-C in der Studienpopulation unabhängig mit MACCE korreliert waren. Die Receiver-Operating-Curve(ROC)-Analyse ergab, dass ein LDL-Wert von mehr als 71 mg/dl ein Prädiktor für MACCE mit einer Sensitivität von 45,4 % und einer Spezifität von 91,8 % (AUC, Fläche unter der Kurve: 0,814; p = 0,02) war.

Schlussfolgerung

Die vorliegende Studie liefert Hinweise dafür, dass niedrigere Serumspiegel für LDL-C und HDL-C unabhängig mit kurzfristig auftretenden MACCE bei Patienten nach TAVI assoziiert sind. Niedrigere Spiegel für LDL-C und HDL-C sind möglicherweise Indikatoren einer schlechten Prognose. Die Bestimmung der Serumlipidspiegel könnte die präoperative Risikobeurteilung potenzieller TAVI-Kandidaten verbessern.

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Abbreviations

DAPT:

Dual antiplatelet therapy

HDL-C:

High-density lipoprotein cholesterol

MACCE:

Major adverse cardiac and cerebrovascular events

LDL-C:

Low-density lipoprotein cholesterol

logistic EuroSCORE:

Logistic European System for Cardiac Operative Risk Evaluation

RDW:

Red cell distribution width

STS:

The Society of Thoracic Surgeons Predictive Risk of Mortality score

TAVI:

Transcatheter aortic valve implantation

WBC:

White blood cell

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Authors and Affiliations

  1. Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 34668, Üsküdar-Istanbul, Turkey

    N. S. Yelgeç MD & A. Emre MD

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  1. N. S. Yelgeç MD
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  2. A. Emre MD
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Correspondence to N. S. Yelgeç MD.

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N.S. Yelgeç and A. Emre declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements.

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Yelgeç, N.S., Emre, A. Prognostic value of lipid levels in short-term outcome after TAVI. Herz 45, 382–388 (2020). https://doi.org/10.1007/s00059-019-4826-3

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  • DOI: https://doi.org/10.1007/s00059-019-4826-3

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