Potential role and prognostic value of erythropoietin levels in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

  • Background: Both EPO levels and anemia have shown prognostic value in several cardiac disorders. An observational study with a prospective follow-up was performed to investigate their independent prognostic roles in severe aortic stenosis. Methods: An up to 36-month follow-up of consecutive patients with severe aortic stenosis undergoing TAVR in a high-volume center was performed. Patients with eGRF <30 mL/min/1.73 m2 were excluded. EPO levels and/or anemia status and its association with mid-term mortality were assessed. Results: Out of 407, 360 met eligibility criteria. Median age was 83 years, with 71.4% having a NYHA class III/IV. Anemia was present in 51.9%, and iron deficiency in 52.8%. Median (IQR) EPO levels were 14.4 (9.30–24.30) mIU/mL. Median follow-up was 566 days. Anemia was associated with overall mortality (HR 2.40, 95% CI 1.51–3.80, p < 0.001). Higher logEPO levels were associated with mid-term mortality (HR 4.05, 95% CI 2.29–7.16, p < 0.001), even after adjusting for clinically and/or statistically relevant factors (multivariate HR 2.25, 95 CI 1.09–4.66, p = 0.029). Kaplan-Meier analyses showed early diverging curves for anemia vs. non-anemia, whereas curves for patients in various EPO level quartiles started to diverge at about 100 days, with differences consistently increasing during the subsequent entire follow-up period. Conclusions: Differently from anemia, which was a strong predictor for both early and late mortality in severe aortic stenosis after TAVR, independent prognostic value of EPO only emerged after post-TAVR recovery. EPO prognostic value was independent from anemia and mild-to-moderate renal dysfunction. High EPO levels could be useful to identify patients with severe aortic stenosis showing a compromised mid-term survival in spite of TAVR use and independently from early TAVR results.

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Author:Silvia Mas-PeiroORCiDGND, Philipp SeppeltORCiDGND, Roberta De RosaORCiD, Marie-Isabel Murray, Jörg Yogarajah, Alexander BerkowitschGND, Stephan Fichtlscherer, Andreas M. ZeiherORCiDGND, Mariuca Vasa-NicoteraORCiDGND
Parent Title (English):Frontiers in Cardiovascular Medicine
Publisher:Frontiers Media
Place of publication:Lausanne
Document Type:Article
Date of Publication (online):2020/11/30
Date of first Publication:2020/11/30
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2020/12/17
Tag:anemia; biomarker; erythropoietin (EPO); prognostic value; transcatheter aortic valve replacement (TAVR), aortic valve stenosis (AS)
Issue:article 605257
SM-P has been supported by a Cardiopulmonary Institute (CPI) grant and a German Center for Cardiovascular Research (DZHK) grant.
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0