Metabolite Profiles Predict Acute Kidney Injury and Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement.
Metabolite Profiles Predict Acute Kidney Injury and Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement.
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DOI：
10.1161/jaha.115.002712
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发表时间：
2016-03-15
影响因子：
5.4
通讯作者：
Gerszten RE
中科院分区：
文献类型：
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作者：
Elmariah S;Farrell LA;Daher M;Shi X;Keyes MJ;Cain CH;Pomerantsev E;Vlahakes GJ;Inglessis I;Passeri JJ;Palacios IF;Fox CS;Rhee EP;Gerszten RE
急性肾损伤（阿基）常发生在经导管主动脉瓣置换术（TAVR）后，与术后死亡率显著增加相关。我们以前确定了预测慢性肾脏疾病的血浆代谢物，但代谢物谱是否可以识别阿基风险尚不清楚。我们对来自接受TAVR的患者和来自基于社区的心脏病研究（N=2164）的受试者的血浆进行了基于液相色谱-质谱的代谢物分析。使用瓣膜学术研究联盟-2标准定义阿基。在接受TAVR的44例患者（平均年龄82±9岁，52%为女性）中，22例（50%）患有慢性肾脏疾病，9例（20%）发生阿基。在分析的85种代谢物中，我们在基于医院的TAVR和心脏瓣膜置换研究队列中检测到与慢性肾脏疾病相关的显著一致的横断面代谢变化。尽管校正了基线肾小球滤过率，但基线5-腺苷同型半胱氨酸水平可预测TAVR后的阿基（每1-SD增加的比值比为5.97，95% CI 1.62-22.0; P=0.007）。在中位随访7.8个月期间，发生阿基的患者中，6例（66.7%）随后死亡，而未发生阿基的患者中有3例（8.6%）死亡（P=0.0008）。5-腺苷高半胱氨酸可预测TAVR后的全因死亡率（风险比/1-SD增加2.96，95% CI 1.33-6.58; P=0.008），与基线肾小球滤过率无关。在接受TAVR的重度主动脉瓣狭窄老年人群中，代谢产物谱可改善阿基的预测。鉴于TAVR后阿基的多因素性质，代谢产物谱可识别肾储备降低的患者。
Acute kidney injury (AKI) occurs commonly after transcatheter aortic valve replacement (TAVR) and is associated with markedly increased postoperative mortality. We previously identified plasma metabolites predictive of incident chronic kidney disease, but whether metabolite profiles can identify those at risk of AKI is unknown. We performed liquid chromatography–mass spectrometry–based metabolite profiling on plasma from patients undergoing TAVR and subjects from the community‐based Framingham Heart Study (N=2164). AKI was defined by using the Valve Academic Research Consortium‐2 criteria. Of 44 patients (mean age 82±9 years, 52% female) undergoing TAVR, 22 (50%) had chronic kidney disease and 9 (20%) developed AKI. Of 85 metabolites profiled, we detected markedly concordant cross‐sectional metabolic changes associated with chronic kidney disease in the hospital‐based TAVR and Framingham Heart Study cohorts. Baseline levels of 5‐adenosylhomocysteine predicted AKI after TAVR, despite adjustment for baseline glomerular filtration rate (odds ratio per 1‐SD increase 5.97, 95% CI 1.62–22.0; P=0.007). Of the patients who had AKI, 6 (66.7%) subsequently died, compared with 3 (8.6%) deaths among those patients who did not develop AKI (P=0.0008) over a median follow‐up of 7.8 months. 5‐adenosylhomocysteine was predictive of all‐cause mortality after TAVR (hazard ratio per 1‐SD increase 2.96, 95% CI 1.33–6.58; P=0.008), independent of baseline glomerular filtration rate. In an elderly population with severe aortic stenosis undergoing TAVR, metabolite profiling improves the prediction of AKI. Given the multifactorial nature of AKI after TAVR, metabolite profiles may identify those patients with reduced renal reserve.