Persistent serpinA3 and periostin levels after TAVR: a reverse cardio-oncology perspective

In severe aortic stenosis (AS), extensive structural and functional myocardial remodelling occurs. Biomolecules released from the remodelled myocardium may contribute to a tumour-promoting microenvironment, a mechanism highlighted in reverse cardio-oncology. SerpinA3 and periostin have been associated with both myocardial remodelling and oncogenesis, yet it is unknown whether their circulating levels are altered after the reverse remodelling that follows transcatheter aortic valve replacement (TAVR).

This study aimed to evaluate the temporal changes in circulating serpinA3 and periostin levels in patients with AS undergoing TAVR.

Twenty-one patients (81 ± 1 years, 52% female) with severe AS underwent TAVR. Echocardiographic assessments and venous blood sampling were performed at three time points: within 24 hours preoperatively (preop), within 24 hours postoperatively (postop), and at six-month follow-up (6MFU). Serum serpinA3 and periostin concentrations were measured using ELISA. Additionally, serum NT-proBNP levels were measured preoperatively and at the 6MFU visit as part of routine clinical laboratory testing.

Baseline left ventricular (LV) ejection fraction was 55 ± 4%. At 6MFU, significant reverse remodelling was observed, including a reduction in global myocardial work index (2395 ± 150 vs. 1947 ± 117 mmHg%, p<0.05) and LV end-diastolic diameter (50.4 ± 2 vs. 44.9 ± 1 mm, p<0.05). NT-proBNP levels showed a decreasing trend (2304 ± 552 vs. 993 ± 146 pg/mL, p=0.057). SerpinA3 concentrations rose markedly in the early postoperative period (262.6 ± 27 to 457.7 ± 50 µg/mL, p<0.001), followed by a decline at 6MFU (457.7 ± 50 to 291 ± 50 µg/mL, p<0.001), although values remained above baseline. Periostin levels were unchanged immediately after TAVR (104.7 ± 6 vs. 100.4 ± 8 ng/mL, p=0.06) but increased significantly by 6MFU (100.4 ± 8 to 128.5 ± 11 ng/mL, p<0.001). When patients were stratified according to oncological history, no differences in baseline or post-procedural serpinA3 or periostin levels were observed between those with or without previous malignancy at any time point.

Contrary to expectations, reverse remodelling induced by TAVR in patients with AS was not accompanied by a reduction in circulating serpinA3 or periostin levels.