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Predictive value of the Fibrosis-4 index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

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Abstract

Background

Liver dysfunction is associated with an increased risk of mortality after cardiac interventions. The Fibrosis-4 (FIB-4 index), a marker of hepatic fibrosis, has been associated with a worse prognosis in heart failure. The prognostic relevance of the index in patients undergoing transcatheter aortic valve replacement (TAVR) is unknown. The aim of this study was to evaluate the clinical implications associated with the FIB-4 index in patients undergoing TAVR.

Methods

Between May 2012 and June 2019, 941 patients undergoing TAVR were stratified into a low or high FIB-4 index group, based on a cutoff value that was determined according to a receiver operating characteristic curve predicting 1-year all-cause mortality.

Results

Patients with a high FIB-4 index (n = 480), based on the cutoff value of 1.82, showed higher rates of pulmonary hypertension (43.8% vs. 31.8%, p < 0.01), right-ventricular systolic dysfunction (29.5% vs. 19.2%, p < 0.01) and larger inferior vena cava diameter (1.6 ± 0.6 cm vs. 1.3 ± 0.6 cm, p < 0.01) than patients with a low FIB-4 index (n = 461). Furthermore, a high FIB-4 index was associated with a significantly higher cumulative 1-year all-cause mortality (17.5% vs. 10.2%, p < 0.01) and non-cardiovascular mortality (12.1% vs. 2.5%, p < 0.01), compared to a low FIB-4 index. Multivariable analysis revealed that a high FIB-4 index was independently associated with all-cause mortality (HR: 1.75 [95% CI: 1.18–2.59], p < 0.01).

Conclusions

A high FIB-4 index is associated with right-sided heart overload and an increased risk of mortality in patients undergoing TAVR. The FIB-4 index may be useful as an additional predictor of outcomes in these patients.

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Acknowledgements

We thank Dr. Meghan Lucas for her critical reading of the manuscript.

Funding

Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—Grant No. 397484323–TRR259.

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Author notes

  1. Vedat Tiyerili, and Baravan Al-Kassou contributed equally to the manuscript.

Authors and Affiliations

  1. Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany

    Mitsumasa Sudo, Jasmin Shamekhi, Alexander Sedaghat, Adem Aksoy, Andreas Zietzer, Tetsu Tanaka, Nihal Wilde, Marcel Weber, Jan-Malte Sinning, Eberhard Grube, Georg Nickenig, Sebastian Zimmer, Vedat Tiyerili & Baravan Al-Kassou

  2. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan

    Mitsumasa Sudo

  3. Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany

    Verena Veulemans & Malte Kelm

  4. Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany

    Matti Adam & Stephan Baldus

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  1. Mitsumasa Sudo
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Corresponding author

Correspondence to Baravan Al-Kassou.

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Conflict of interest

Drs. Sinning, Grube, Tiyerili, Zimmer, Adam and Nickenig have received speaker honoraria and research grants from Abbott, Abiomed, Medtronic, Boston Scientific, and Edwards Lifesciences. Dr. Veulemans has received speaker and/or study honoraria from Edwards Lifesciences and Medtronic. Dr. Kelm has received institutional grant support and/or personal fees from Philips, Abott, Medtronik, Boston Scientific, Mars, Boehringer Ingelheim, Daiichi-Sankyo GmbH, Amgen, Ancora Heart, and B. Braun. Dr. Grube is a proctor for Boston Scientific and Medtronic. Dr. Sudo has received manuscript fees from Boston Scientific Japan KK. The other authors report no conflicts of interest.

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Sudo, M., Shamekhi, J., Sedaghat, A. et al. Predictive value of the Fibrosis-4 index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Clin Res Cardiol 111, 1367–1376 (2022). https://doi.org/10.1007/s00392-022-02055-6

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  • DOI: https://doi.org/10.1007/s00392-022-02055-6

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