Enzyme ratio could help cardiologists track risk of stroke, AFib after TAVR
Tracking a patient’s De Ritis ratio before transcatheter aortic valve replacement (TAVR) may help predict their risk of experiencing a stroke, acute kidney injury (AKI) or new-onset atrial fibrillation (AFib), according to new data published in PLoS One.[1]
The De Ritis ratio evaluates the concentrations of two liver enzymes, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). It is sometimes referred to as a patient’s AST/ALT ratio. Prior studies have suggested the De Ritis ratio could provide value for heart teams. However, researchers noted, potential relationships between this ratio and TAVR outcomes have not been thoroughly explored.
“A growing body of literature has explored novel biomarkers for preprocedural risk stratification after TAVR, including inflammatory, metabolic, renal, myocardial, and nutritional indices,” wrote corresponding author Mohammad Alnees, MD, a researcher with the Hebrew University of Jerusalem and Harvard Medical School, and colleagues. “Such biomarkers may capture multisystem physiologic vulnerability that is not fully reflected by conventional clinical risk scores alone.”
Alnees et al. retrospectively tracked data from more than 700 patients who underwent transfemoral TAVR from 2016 to 2025 at a single facility. Anyone who presented with liver cirrhosis or died within 24 hours of undergoing TAVR were excluded from the team’s analysis.
Patients were categorized based on their baseline AST/ALT ratio. While 65% of patients were put into a low-ratio group due to an AST/ALT ratio < 1.4, the remaining 35% of patients were put into a high-ratio group with an AST/ALT ratio ≥ 1.4.
Overall, 30 days after TAVR, patients in the high-ratio group were associated with an increased risk of stroke, AKI or new-onset AFib. However, there was not a significantly higher risk of all-cause mortality.
“These findings suggest that the AST/ALT ratio may serve as a candidate risk marker, although the observational design does not permit causal inference or immediate clinical implementation,” the authors wrote. “Importantly, the ≥ 1.4 threshold was adopted from prior cardiovascular literature rather than derived within a TAVR-specific cohort; it should therefore be regarded as a literature-based exploratory cut-off that requires external validation in dedicated TAVR populations.”
The researchers emphasized that additional research is still necessary to better understand the relationship between this straightforward enzyme ratio and short-term TAVR outcomes.
“External validation with longer follow-up is required before clinical implementation,” they concluded.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.