Tumour necrosis factor-alpha serum level is an independent predictor of medium-term all-cause mortality after transcatheter aortic valve replacement

Abstract

Background

Transcatheter aortic valve implantation (TAVI) is a suitable treatment for patients with severe aortic stenosis and severely increased operative risk. There is need for a better preoperative risk assessment for TAVI candidates.

Aim

To determine whether Tumour necrosis factor-alfa (TNFα) is an independent predictor of survival 500 days after TAVI.

Methods

Sixty patients undergoing TAVI were enrolled in the study. TNFα was determined. The CT measured low-density muscle fraction (LDM%) of the psoas muscle was determined. Operative risk assessment by Logistic EuroSCORE, EuroSCORE II, and STS score was performed. Frailty scores (FRAIL scale and Barthel index) were determined.

Results

Mean age was 81.01 ± 7.54 years. Twenty-six (43.3%) of the patients were males. In the univariable analyses, FRAIL scale and Barthel index were no predictors of survival after TAVI. In the multivariable analysis, including EuroSCORE II, LDM% and TNFα serum concentration, TNFα serum level was an independent predictor of survival 500 days after TAVI (HR: 3.167; 95%: 1.279–7.842; p = 0.013). The multivariable analysis, including TNFα as a categorical variable, showed that compared to patients in the conjugated first and second TNFα serum level tertile, patients in the third tertile had a hazard ratio (HR) of 10.606 (95%CI: 1.203 − 93.467) (p = 0.033).

Conclusion

TNFα is an incremental independent predictor of long-term survival after TAVI.

Keywords:

• Transcatheter aortic valve implantation (TAVI)
• 500-day survival
• all-cause mortality
• tumour necrosis factor alpha (TNFα)
• low-density muscle fraction of the psoas muscle (LDM%)

Disclosure statement

HH: Dr. Heidbuchel did not receive any personal honoraria. He received unconditional research grants through the University of Antwerp and/or the University of Hasselt from Bayer, Boehringer-Ingelheim,Bracco Imaging Europe, Abbott, Medtronic, Biotronik, Daicchi-Sankyo, Pfizer-BMS, and Boston-Scientific, all outside the scope of this work. JB: Dr. Bosmans is a proctor for Medtronic CoreValve.