Cardiac Biomarkers in Patients With Asymptomatic Severe Aortic Stenosis: Analysis From the EARLY TAVR Trial

作者：Brian R. Lindman, Philippe Pîbarot, Allan Schwartz, J. Bradley Oldemeyer, Y. Su, Kashish Goel, David J. Cohen, William F. Fearon, Vasilis Babaliaros, David J. Daniels, Adnan K. Chhatriwalla, Hussam Suradi, Pinak Shah, Molly Szerlip, Michael J. Mack, Thom Dahle, William W. O’Neill, Charles J. Davidson, Raj Makkar, Tej Sheth, Jeremiah P. Depta, James T. DeVries, Jeffrey Southard, Andrei Pop, Paul Sorajja, Rebecca T. Hahn, Yanglu Zhao, Martin B. Leon, Philippe Généreux · 发表于：Circulation · 年份：2025 · DOI：10.1161/circulationaha.125.074425 · 被引用次数：22 · 研究领域：Cardiac Valve Diseases and Treatments、Cardiovascular Function and Risk Factors、Cardiomyopathy and Myosin Studies

BACKGROUND: The EARLY TAVR trial (Evaluation of TAVR Compared to Surveillance for Patients With Asymptomatic Severe Aortic Stenosis) demonstrated that early transcatheter aortic valve replacement (TAVR) intervention was superior to clinical surveillance with delayed TAVR in patients with asymptomatic severe aortic stenosis. Cardiac biomarkers are associated with maladaptive remodeling, symptom onset, and worse outcomes after TAVR. Whether elevated biomarkers identify asymptomatic patients more likely to benefit from early intervention is unknown. METHODS: A core laboratory measured NT-proBNP (N-terminal pro–B-type natriuretic peptide) and high-sensitivity cardiac troponin T (hs-cTnT) levels. Associations between biomarker levels and risk of the trial primary end point (death, stroke, or unplanned cardiovascular hospitalization) and other secondary end points were examined with Kaplan-Meier curves and Cox proportional hazard models. Interaction tests were performed to assess whether the treatment effect of early TAVR, compared with clinical surveillance, differed according to biomarker levels. RESULTS: Among 901 patients randomized in EARLY TAVR, 798 (89%) had biospecimens measured (median NT-proBNP level, 287 [145, 601]; median hs-cTnT level, 14.6 [10.5, 21.0]). Higher levels of NT-proBNP and hs-cTnT were broadly associated with higher event rates for multiple end points. In general, there was no significant interaction between baseline biomarkers and treatment group with res...