Comparative Analysis of the Kinetic Behavior of Systemic Inflammatory Markers in Patients with Depressed versus Preserved Left Ventricular Function Undergoing Transcatheter Aortic Valve Implantation

Abstract

Background: Prior studies have proven the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with reduced left ventricular (LV) function. This study’s aim was to investigate periprocedural inflammatory responses after TAVI. Methods: Patients with severe symptomatic aortic stenosis and reduced LV function who underwent transfemoral TAVI were enrolled. A paired-matched analysis (1:2 ratio) was performed using patients with preserved LV function. Whole white blood cells (WBC) and subpopulation dynamics as well as the neutrophil to lymphocyte ratio (NLR) were evaluated at different times. Results: A total of 156 patients were enrolled, including 52 patients with LVEF < 40% 35.00 [30.00, 39.25] and 104 with LVEF > 50% 55.00 [53.75, 60.0], p < 0.001. Baseline NLR in the reduced LV function group was significantly higher compared to the preserved LV function group, 2.85 [2.07, 4.78] vs. 3.90 [2.67, 5.26], p < 0.04. After a six-month follow-up, the inflammatory profile was found to be similar in the two groups, NLR 2.94 [2.01, 388] vs. 3.30 [2.06, 5.35], p = 0.288. No significant mortality differences between the two groups were observed in the long-term outcome. Conclusions: TAVI for severe symptomatic aortic stenosis, with reduced LV function, was associated with an improvement in the inflammatory profile that may account for some of the observable benefits of the procedure in this subset of patients.

Neutrophil-to-lymphocyte ratio as a predictor of inflammatory response in patients with acute kidney injury after transcatheter aortic valve implantation

“…The NLR was pointed out as a marker of systemic inflammation and worse prognosis in patients with HF. 7,8 Moreover, systemic inflammation has been recognized as a dominant feature of HF deterioration, 26 particularly when reduction in left ventricular function is observed. 26,27 Aortic stenosis is characterized with constant progression of HF.…”

“…7,8 Moreover, systemic inflammation has been recognized as a dominant feature of HF deterioration, 26 particularly when reduction in left ventricular function is observed. 26,27 Aortic stenosis is characterized with constant progression of HF. The pathogenesis of calcific aortic stenosis is multifactorial.…”

“…34 Abu Khadija et al showed that the reduction of the NLR as an inflammatory marker after TAVI in group with reduced left ventricular function caught up with the NLR in patients with preserved left ventricular function after 6 months of follow-up. 26 Condado et al showed that elevated NLR and plateletlymphocyte ratio (PLR) are associated with a higher Society of Thoracic Surgeons -Predicted Risk of Mortality (STS-PROM) score. 35 Therefore, high NLR may characterize patients with higher perioperative risk.…”

Trends in Transfemoral Aortic Valve Implantation Related Thrombocytopenia

“…The use of iodinated contrast agents is another possible etiologic factor [2,17]. These contrast agents' chemical properties, immune-allergic reactions or genetic predispositions, and provide explanations for these relationships.…”

“…The current explanation for the TAVI-rTP mechanism is platelet activation and a systemic inflammatory response [2,[15][16][17]. Even though TAVI-rTP has been thoroughly described, a comprehensive understanding of this phenomenon needs further investigation.…”