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.
Highlights
Surgical aortic valve replacement performed in patients with reduced left ventricular ejection fraction (LVEF) is associated with worse patient outcomes [1,2]
Kaplan Meir curve based on all cause mortality for patients underwent transcatheter aortic valve implantation (TAVI), showing no difference in
Dithisrceudsusicoend LV function compared with preserved LV function is reflected by a higher baseline neutrophil to lymphocyte ratio (NLR); (ii) the effect of the TAVI on the reduction of the NLR inflammatory marker in the reduced LV group caught up with the NLR in the preserved LV function group after six months of follow-up; (iii) there are favorable clinical outcomes, independent of the baseline LV function
Summary
Surgical aortic valve replacement performed in patients with reduced left ventricular ejection fraction (LVEF) is associated with worse patient outcomes [1,2]. Inflammation has been linked to disease development, progression, and associated complications, and is predictive of poor patient outcomes, independent of LVEF [12,13,14]. One such inflammatory biomarker is the NLR, which is derived from routine complete blood counts. Prior studies have proven the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with reduced left ventricular (LV) function. 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
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