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Predictive value of the Fibrosis-4 index in patients with severe aortic stenosis undergoing transcatheter aortic
Mitsumasa Sudo1,2, Jasmin Shamekhi1, Alexander Sedaghat1
1Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Insights
A high Fibrosis-4 (FIB-4) index indicates liver fibrosis and is linked to increased mortality risk in patients undergoing transcatheter aortic valve replacement (TAVR). This marker may help predict outcomes in TAVR patients.
Area of Science:
- Cardiology
- Hepatology
- Medical Diagnostics
Background:
- Liver dysfunction increases mortality risk post-cardiac interventions.
- The Fibrosis-4 (FIB-4) index, a marker for hepatic fibrosis, is linked to poorer outcomes in heart failure patients.
- The prognostic value of the FIB-4 index in transcatheter aortic valve replacement (TAVR) patients is not well-established.
Purpose of the Study:
- To investigate the clinical implications of the FIB-4 index in patients undergoing TAVR.
- To determine if FIB-4 index predicts mortality risk in TAVR patients.
Main Methods:
- A cohort of 941 patients undergoing TAVR between May 2012 and June 2019 was analyzed.
- Patients were stratified into low or high FIB-4 index groups using a cutoff value derived from a receiver operating characteristic curve for 1-year all-cause mortality.
- The cutoff value for a high FIB-4 index was determined to be 1.82.
Main Results:
- Patients with a high FIB-4 index (n=480) exhibited higher rates of pulmonary hypertension, right-ventricular systolic dysfunction, and larger inferior vena cava diameter compared to those with a low FIB-4 index (n=461).
- A high FIB-4 index was associated with significantly higher cumulative 1-year all-cause mortality (17.5% vs. 10.2%) and non-cardiovascular mortality (12.1% vs. 2.5%).
- Multivariable analysis confirmed that a high FIB-4 index was an independent predictor of all-cause mortality (HR: 1.75 [95% CI: 1.18-2.59]).
Conclusions:
- Elevated FIB-4 index in TAVR patients correlates with right-sided heart overload.
- A high FIB-4 index is associated with an increased risk of mortality following TAVR.
- The FIB-4 index shows potential utility as an additional prognostic tool for TAVR patient outcomes.
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.
