Abstract
BackgroundTranscatheter aortic valve replacement (TAVR) is the method of choice for patients with severe aortic valve stenosis, who are ineligible or at high risk for surgery. Though TAVR leads to a significant reduction in mortality, a notable amount of patients are re-hospitalized early after TAVR. Parameters or biomarkers predicting outcome are therefore needed to identify patients who benefit most. Specific monocyte subsets have been associated with cardiovascular diseases and were shown to possess prognostic value.MethodsPeripheral blood was drawn before and after transfemoral TAVR with the self-expanding CoreValve, Boston Lotus or the balloon-expanding Edwards Sapien prosthesis. Classical (CD14++CD16−), intermediate (CD14++CD16+) and non-classical (CD14+CD16++) monocyte subsets were determined by flow cytometry. Transthoracic echocardiography was performed before, early after as well as 3 months after the TAVR procedure.ResultsNo significant differences in the absolute monocyte counts were found after TAVR. A significant decline in the intermediate monocyte population was though observed early after TAVR (pre 4.01±0.38%, post 2.803±0.34%, p≤0.05). Creatinine levels stayed stable after TAVR procedure and intermediate monocytes were associated with worse renal function. Monocyte decline was not related to changes in CRP-, noradrenaline, cortisol or aldosterone-levels. The amount of intermediate monocytes correlated with worse cardiac function and predicted the possibility to reach an improvement in NYHA functional class at 3 months after TAVR.ConclusionsA significant decline of intermediate monocytes occurs shortly after TAVR. High levels of intermediate monocytes were associated with worse cardiac function and predicted poor functional capacity, hinting at a possible prognostic value.
Highlights
Transcatheter aortic valve replacement (TAVR) has become the method of choice for patients with severe aortic valve stenosis who are ineligible or at high perioperative risk for conventional aortic valve replacement.[1,2,3,4,5] Even though, TAVR significantly improves symptoms and reduces mortality, a relevant amount of patients are re-hospitalized early after valve implantation.[6,7,8,9,10] For perioperative risk assessment, scores like the STS risk score or EuroSCORE II are used
No significant differences in the absolute monocyte counts were found after TAVR
Creatinine levels stayed stable after TAVR procedure and intermediate monocytes were associated with worse renal function
Summary
Transcatheter aortic valve replacement (TAVR) has become the method of choice for patients with severe aortic valve stenosis who are ineligible or at high perioperative risk for conventional aortic valve replacement.[1,2,3,4,5] Even though, TAVR significantly improves symptoms and reduces mortality, a relevant amount of patients are re-hospitalized early after valve implantation.[6,7,8,9,10] For perioperative risk assessment, scores like the STS risk score or EuroSCORE II are used. Not all comorbidities are reflected in these scores and characteristics such as frailty are not considered These risk scores assess surgical risk and were shown to be imprecise predictors of outcome after TAVR.[11] Different biomarkers such as B-type natriuretic peptide or growth differentiation factor-15 have been reported to predict outcome after TAVR as well, and were suggested to improve patient selection.[12,13,14] additional parameters or biomarkers predicting outcome after TAVR are needed to identify patients who benefit most. Specific monocyte subsets have been associated with cardiovascular diseases and were shown to possess prognostic value
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