Methods: In this prospective cohort study, we included 53 consecutive individuals with severe symptomatic aortic stenosis admitted for TAVI. Patients underwent core laboratory echocardiographic assessment at baseline and follow-up at 6 and 12 months. Primary endpoint was LVEF recovery ≥ 10 % within 12 months after TAVI. Progranulin plasma levels were determined using BioVendor RMEE103R Human ELISA Kit prior TAVI. Correlation analysis and receiver operator characteristics were performed.
Results: Baseline characteristics are shown in Table 1. A total of 15 (28.3%) out of 53 patients had LVEF ≤ 50 %. Of those 53.3 % showed LVEF recovery following TAVI at 6 and 12 months, respectively: 40.6 ± 6.6 % vs. 47.1 ± 14.1, p = 0.034 and 48.5 ± 10.8, p = 0.09. Progranulin plasma concentrations at baseline were increased in patients with reduced LVEF (< 35 %) and mid-range LVEF (50 – 35 %) compared to patients with preserved LVEF (> 50 %), p = 0.012, Table 2. Correlation analysis revealed an association between baseline Progranulin and LVEF recovery upon follow-up, r = 0.711, p = 0.001. Progranulin was able to predict intermediate recovery of systolic left ventricular fraction with an area under the curve of 0.911, 95 % CI 0.763 – 0.999, p = 0.008.
Conclusions: In this pilot-study we found LVEF recovery in half of patients with prior reduced LVEF undergoing TAVI. Baseline Progranulin may be a promising biomarker for prediction of intermediate recovery of systolic LVEF. However, future studies in larger cohorts need to confirm results.
Table 1. Baseline patients’ characteristics
|
|
Overall |
LVEF ≤ 50 % |
|
Gender female n [%] |
23 (43.4) |
5 (33.3) |
|
Age [years] |
80.4 ± 5.1 |
81.4 ± 4.3 |
|
BMI [kg/m2] |
28.6 ± 5.3 |
27.0 ± 4.8 |
|
NYHA functional class |
|
|
|
II n [%] |
12 (22.6) |
3 (20.0) |
|
III n [%] |
36 (67.9) |
10 (66.6) |
|
IV n [%] |
5 (9.4) |
2 (13.3) |
|
Atrial fibrillation n [%] |
26 (49.1) |
10 (66.7) |
|
CAD n [%] |
41 (77.4) |
14 (93.3) |
|
PAD n [%] |
13 (24.5) |
6 (40.0) |
|
Arterial hypertension n [%] |
49 (92.5) |
14 (93.3) |
|
Stroke n [%] |
6 (11.3) |
1 (6.7) |
|
Valve type |
|
|
|
Edwards Sapien 3 n [%] |
16 (30.2) |
6 (40.0) |
|
Edwards Sapien XT n [%] |
1 (1.9) |
0 (0.0) |
|
Medtronic Evolut R n [%] |
25 (47.2) |
0 (0.0) |
|
Medtronic Evolut Pro n [%] |
6 (11.3) |
3 (20.0) |
|
Medtronic Evolut Corevalve n [%] |
5 (9.4) |
6 (40.0) |
BMI = body mass index; CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; LVEF = left ventricular ejection fraction; NYHA = New York Health Association; PAD = peripheral artery disease.
Table 2. Progranulin concentration before TAVI
|
|
LVEF > 50 % n = 36 |
LVEF 50 - 35 % n = 12 |
LVEF < 35 % n = 3 |
|
Progranulin [pg/ml] |
33.9 ± 8.6 |
33.3 ± 10.8 p = 0.810 |
49.3 ± 10.4 p = 0.012* |
LVEF = left ventricular ejection fraction. All p-values compared to patients with LVEF > 50 %. * denotes p ≤ 0.05.
Figure 1. Receiver operating characteristic curve for Progranulin concentrations prior TAVI and post-procedural left ventricular ejection fraction recovery
Left ventricular ejection fraction recovery was defined ≥ 10 % upon follow-up. * denotes p ≤ 0.05.
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