Clinical Trials Center Cardiovascular Research Foundation New York NY.
Division of Cardiology NewYork-Presbyterian Hospital/Columbia University Medical Center New York NY.
J Am Heart Assoc. 2022 Jun 7;11(11):e024091. doi: 10.1161/JAHA.121.024091. Epub 2022 Jun 3.
Background The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammation has been associated with worse prognosis in several chronic disease states, including heart failure. However, few data exist on the prognostic impact of elevated baseline NLR or change in NLR levels during follow-up in patients undergoing transcatheter or surgical aortic valve replacement (TAVR or SAVR) for aortic stenosis. Methods and Results NLR was available in 5881 patients with severe aortic stenosis receiving TAVR or SAVR in PARTNER (Placement of Aortic Transcatheter Valves) I, II, and S3 trials/registries (median [Q1, Q3] NLR, 3.30 [2.40, 4.90]); mean NLR, 4.10; range, 0.5-24.9) and was evaluated as continuous variable and categorical tertiles (low: NLR ≤2.70, n=1963; intermediate: NLR 2.70-4.20, n=1958; high: NLR ≥4.20, n=1960). No patients had known baseline infection. High baseline NLR was associated with increased risk of death or rehospitalization at 3 years (58.4% versus 41.0%; adjusted hazard ratio [aHR], 1.39; 95% CI, 1.18-1.63; <0.0001) compared with those with low NLR, irrespective of treatment modality. In both patients treated with TAVR and patients treated with SAVR, NLR decreased between baseline and 2 years. A 1-unit observed decrease in NLR between baseline and 1 year was associated with lower risk of death or rehospitalization between 1 year and 3 years (aHR, 0.86; 95% CI, 0.82-0.89; <0.0001). Conclusions Elevated baseline NLR was independently associated with increased subsequent mortality and rehospitalization after TAVR or SAVR. The observed decrease in NLR after TAVR or SAVR was associated with improved outcomes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00530894, NCT0134313, NCT02184442, NCT03225001, NCT0322141.
背景 中性粒细胞与淋巴细胞比值（NLR）作为全身炎症的标志物，与心力衰竭等多种慢性疾病状态的预后不良有关。然而，在接受经导管或外科主动脉瓣置换术（TAVR 或 SAVR）治疗的主动脉瓣狭窄患者中，关于基线 NLR 升高或随访期间 NLR 水平变化的预后影响的数据很少。
方法和结果 PARTNER（经导管主动脉瓣置换术）I、II 和 S3 试验/登记处纳入了 5881 例严重主动脉瓣狭窄患者，接受了 TAVR 或 SAVR 治疗（NLR 中位数[Q1，Q3]，3.30[2.40，4.90]；平均 NLR，4.10；范围，0.5-24.9），并将其作为连续变量和三分位数进行评估（低：NLR≤2.70，n=1963；中：NLR 2.70-4.20，n=1958；高：NLR≥4.20，n=1960）。所有患者均无已知的基线感染。高基线 NLR 与 3 年时死亡或再住院风险增加相关（58.4%比 41.0%；调整后的危险比[aHR]，1.39；95%CI，1.18-1.63；<0.0001），与 NLR 较低的患者相比，无论治疗方式如何。在接受 TAVR 和 SAVR 治疗的患者中，NLR 均从基线水平下降至 2 年。与基线相比，1 年内 NLR 观察到的 1 个单位下降与 1 年至 3 年期间的死亡或再住院风险降低相关（aHR，0.86；95%CI，0.82-0.89；<0.0001）。
结论 基线 NLR 升高与 TAVR 或 SAVR 后死亡率和再住院率增加独立相关。TAVR 或 SAVR 后 NLR 的观察下降与结局改善相关。注册网址：https://www.clinicaltrials.gov；唯一标识符：NCT00530894、NCT0134313、NCT02184442、NCT03225001、NCT0322141。
