Impact of Systemic Inflammatory Response Syndrome on Clinical, Echocardiographic, and Computed Tomographic Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation.

Tarek A N Ahmed,Bon-Kwon Koo,Hyo-Soo Kim,Han-Mo Yang,You-Jeong Ki,Hyun-Jae Kang,Kyung Woo Park,Jeehoon Kang,You-Jung Choi,Jung-Kyu Han,Heba M El-Naggar

doi:10.3389/fcvm.2021.746774

Abstract

BackgroundSystemic inflammatory response syndrome (SIRS) is a systemic insult that has been described with many interventional cardiac procedures. The outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) are thought to be influenced by this syndrome not only on short-term, but also on long-term.ObjectiveWe assessed the association of SIRS to different clinical, echocardiographic, and computed tomographic (CT) outcomes after TAVI.MethodsTwo hundred and twenty-four consecutive patients undergoing TAVI were enrolled in this study. They were assessed for the occurrence of SIRS within the first 48 h after TAVI. Patients were followed-up for short- and long-term clinical outcomes. Serial echocardiographic follow-ups were conducted at 1-week, 6-months, and 1-year. CT follow-up at 1 year was recorded.ResultsEighty patients (36%) developed SIRS. Among different parameters, only pre-TAVI total leucocytic count (TLC), pre-TAVI heart rate, and post-TAVI systolic blood pressure independently predicted the occurrence of SIRS. The incidence of HALT was not significantly different between both groups, albeit higher among SIRS patients (p = 0.1) at 1-year CT follow-up. Both groups had similar patterns of LV recovery on serial echocardiography. Long-term follow-up showed that all-cause death, cardiac death, and re-admission for heart failure (HF) or acute coronary syndrome (ACS) were significantly more frequent among SIRS patients. Early safety and clinical efficacy outcomes were more frequently encountered in the SIRS group, while device-related events and time-related valve safety were comparable.ConclusionAlthough SIRS implies an early acute inflammatory status post-TAVI, yet its clinical sequelae seem to extend to long-term clinical outcomes.

Highlights

The outcome of patients undergoing surgical or interventional therapy is unfavorably influenced by severe systemic inflammation
Only pre-transcatheter aortic valve implantation (TAVI) total leucocytic count (TLC), pre-TAVI heart rate, and post-TAVI systolic blood pressure independently predicted the occurrence of Systemic inflammatory response syndrome (SIRS)
Long-term follow-up showed that all-cause death, cardiac death, and re-admission for heart failure (HF) or acute coronary syndrome (ACS) were significantly more frequent among SIRS patients

Summary

Introduction

The outcome of patients undergoing surgical or interventional therapy is unfavorably influenced by severe systemic inflammation. Systemic inflammatory response syndrome (SIRS) has been reported to frequently occur in the setting of TAVI. Periprocedural hypotension and suboptimal organ perfusion with ischemiareperfusion injury and subsequent cytokine release have been suspected to play a role in the pathogenesis of SIRS post-TAVI [1, 2]. Inflammation have been suggested as a contributor to the pathogenesis of acute and chronic heart failure [4]. Systemic inflammatory response syndrome (SIRS) is a systemic insult that has been described with many interventional cardiac procedures. The outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) are thought to be influenced by this syndrome on short-term, and on long-term

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Conclusion