The role of Matrix Metalloproteinase-2 and Galectin-3 as predictive biomarkers for all-cause mortality in patients undergoing transfemoral transcatheter aortic valve implantation

Abstract

Background

Currently available risk scores fail to accurately predict morbidity and mortality in patients with severe symptomatic aortic stenosis who undergo transcatheter aortic valve implantation (TAVI). In this context, biomarkers like matrix metalloproteinase-2 (MMP-2) and Galectin-3 (Gal-3) may provide additional prognostic information.

Methods

Patients with severe aortic stenosis undergoing consecutive, elective, transfemoral TAVI were included. Baseline demographic data, functional status, echocardiographic findings, clinical outcomes and biomarker levels were collected and analysed.

Results

The study cohort consisted of 89 patients (age 80.4 ± 5.1 years, EuroScore II 7.1 ± 5.8%). During a median follow-up period of 526 d, 28 patients (31.4%) died. Among those who died, median baseline MMP-2 (alive: 221.6 [170.4; 263] pg/mL vs. deceased: 272.1 [225; 308.8] pg/mL, p < 0.001) and Gal-3 levels (alive: 19.1 [13.5; 24.6] pg/mL vs. deceased: 25 [17.6; 29.5] pg/mL, p = 0.006) were higher than in survivors. In ROC analysis, MMP-2 reached an acceptable level of discrimination to predict mortality (AUC 0.733, 95% CI [0.62; 0.83], p < 0.001), but the predictive value of Gal-3 was poor (AUC 0.677, 95% CI [0.56; 0.79], p = 0.002). Kaplan–Meier and Cox regression analyses showed that patients with MMP-2 and Gal-3 concentrations above the median at baseline had significantly impaired long-term survival (p = 0.004 and p = 0.02, respectively).

Conclusions

In patients with severe aortic stenosis undergoing transfemoral TAVI, MMP-2 and to a lesser extent Gal-3, seem to have additive value in optimizing risk prediction and streamlining decision-making.

Keywords:

• TAVI
• survival prediction
• biomarkers
• Galectin-3
• MMP-2

Author contribution statement

Conceptualization O.D., C.L, W.-K. K., H.M.N and C.W.H.; methodology O.D., C.L, W.-K. K.; data curation O.D., L.S.; S.K., J.T.H.; formal analysis S.K., J.T.H., writing – original draft preparation K.P.; writing – review and editing K.P., O.D., M.A., F.J.H., C.L, W.-K. K., S.T.S, H.M.N and C.W.H; supervision, O.D., C.L, W.-K. K., S.T.S, H.M.N and C.W.H.; All authors have read and agreed to the published version of the manuscript.

Disclosure statement

All authors have nothing to disclose relevant to this work.

Data availability statement

Data will be made available upon reasonable request.

Additional information

Funding

This work was supported by Collaborative Research Center 1213-Pulmonary Hypertension and Cor Pulmonale, German Research Foundation (DFG).