Osteoprotegerin levels predict mortality in patients with symptomatic aortic stenosis

Ueland T, Aukrust P, Dahl CP, Husebye T, Solberg OG, Tonnessen T, Aakhus S, Gullestad L (Oslo University Hospital Rikshospitalet; University of Oslo; Oslo University Hospital Rikshospitalet; Oslo University Hospital Ulleval; Oslo University Hospital Rikshospitalet; and Oslo University Hospital Ulleval, Oslo, Norway). Osteoprotegerin levels predict mortality in patients with symptomatic aortic stenosis. J Intern Med 2011; 270: 452-460. Objectives. To examine the prognostic value of osteoprotegerin (OPG) levels in relation to all-cause mortality in patients with symptomatic severe aortic stenosis (AS). Design. We measured plasma OPG levels in 136 patients with symptomatic severe AS and investigated associations with transvalvular gradients, valve area, valve calcification(usingul trasonic backscatter analysis as an estimate) and measures of heart failure. Then, we assessed the prognostic value of elevated plasma OPG in determining all-cause mortality (n = 29) in these patients. Results. Elevated OPG was poorly correlated with the degree of AS but was associated with increased backscatter measurements and impaired cardiac function. Furthermore, OPG was associated with all-cause mortality in patients with symptomatic AS, even after adjustment for conventional risk markers. The strongest association was obtained by using a combination of high levels of both OPG and N-terminal pro-brain natriuretic peptide (NT-proBNP), suggesting that these markers may reflect distinct pathways in the development and progression of AS. Conclusion. The level of circulating OPG is significantly associated with all-cause mortality alone and in combination with NT-proBNP in patients with severe symptomatic AS.