Key result
A pre-procedural neutrophil-to-lymphocyte ratio ≥4.0 was associated with a higher rate of major adverse cardiac events after TAVR compared to a ratio <4.0 (68.4% vs 31.6%, P=0.02).
Why the study?
Does an elevated pre-procedural neutrophil-to-lymphocyte ratio predict heart failure readmissions and major adverse cardiac outcomes in patients undergoing TAVR?
Cohort (n=298)
No
Does an elevated pre-procedural neutrophil-to-lymphocyte ratio predict heart failure readmissions and major adverse cardiac outcomes in patients undergoing TAVR?
Effect estimate: AUC 0.65 (95% CI 0.51-0.79)
Absolute Event Rate: 68.4% vs 31.6%
p-value: p=0.02
An elevated pre-procedural neutrophil-to-lymphocyte ratio (≥4.0) is a significant predictor of 1-year major adverse cardiac events and heart failure hospitalizations following TAVR, and improves the predictive value of the TAVR risk score.
OBJECTIVE: Neutrophil-to-lymphocyte ratio (NLR) has prognostic value in acute coronary syndromes. We investigated its utility for predicting heart failure (HF) admissions and major adverse cardiac outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS: Data on clinical, laboratory, procedural, HF admissions, and major adverse cardiac events (MACEs) (all-cause mortality, recurrence of myocardial infarction requiring intervention, stroke) for 298 consecutive patients who underwent TAVR between 2012 and 2016 in our tertiary center were collected. RESULTS: Analysis included 298 patients. The mean age was 83 ± 8 years, 51% were males, and 95% were Caucasians. The median Society of Thoracic Surgeons risk score was 9 (interquartile range: 6.3-11.8). Receiver-operating curve analysis identified a cutoff value of NLR of 4.0 for MACE after TAVR and sensitivity of 68% and specificity of 68% {area under the curve [AUC] = 0.65 [95% confidence interval (CI): 0.51-0.79], p = 0.03}. An NLR of 4.0 for HF hospitalizations after TAVR and sensitivity of 60% and specificity of 57% [AUC = 0.61 (95% CI: 0.53-0.69), p = 0.01]. NLR ≥4.0 before TAVR significantly predicted MACE after TAVR (68.4% vs. 31.6%, p = 0.02) and HF hospitalizations (58.3% vs. 41.7%, p = 0.03). NLR with TAVR risk score increased the predictive value for MACE after TAVR from AUC = 0.61 (95% CI: 0.50-0.72, p = 0.06) to AUC = 0.69 (95% CI: 0.57-0.80, p = 0.007). CONCLUSION: NLR predicts all-cause mortality, MACE, and HF hospitalization 1 year after TAVR. NLR with TAVR risk score improved predictability for MACE. Further studies for prognostication using NLR are warranted.
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Khalil et al. (2018) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=298). Neutrophil-to-lymphocyte ratio (NLR) ≥4.0 vs. NLR <4.0 was evaluated on Major adverse cardiac events (MACEs) after TAVR (AUC 0.65, 95% CI 0.51-0.79, p=0.02). A pre-procedural neutrophil-to-lymphocyte ratio ≥4.0 was associated with a higher rate of major adverse cardiac events after TAVR compared to a ratio <4.0 (68.4% vs 31.6%, P=0.02).
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