Totaro Antonio, Testa Gianluca, Calafiore Antonio M, Ienco Vincenzo, Sacra Vincenzo, Busti Andrea, Pierro Antonio, Sperlongano Simona, Golino Paolo, Sacra Cosimo
Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy.
Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
J Card Surg. 2022 Dec;37(12):5095-5102. doi: 10.1111/jocs.17212. Epub 2022 Nov 15.
In this prospective multicenter analysis, we aimed to investigate the predictive role of neutrophil/lymphocyte ratio (NLR) in permanent pacemaker implantation (PPI) in patients undergoing transcatheter aortic valve replacement (TAVR).
One hundred and seventy-nine consecutive patients without previous PPI underwent TAVR from February 2017 to September 2021. Patients were further divided based on presence (n = 48) and absence of conduction abnormalities (CAs) at hospital admission (n = 131).
In patients with previous CAs, NLR values did not differ significantly between patients requiring PPI (n = 16, 33%) and those not requiring it. In contrast, in patients with no CAs at hospital admission, NLR values measured at admission and on TAVR day were significantly higher in patients requiring PPI (n = 17, 13%) (4.07 ± 3.22 vs. 3.01 ± 1.47, p = .025, and 10.81 ± 7.81 vs. 5.84 ± 3.78, p = .000, respectively). Multivariable analysis showed that NLR at TAVR day was an independent predictor of PPI in patients without CAs (OR 1.294; 95% CI 1.028-1.630; p = .028), but not in those with previous CAs. ROC curve analysis showed that the cut point was a NLR value of >7.25. Time to PPI was delayed till 21 days in patients without CAs.
In this prospective study, higher NLR values on the day of TAVR day were associated with an increased PPI rate in patients undergoing TAVR with no previous CAs. It is advisable, being inflammation part of the process, to prolong the time of observation for all patients without CAs till at least 21 days not to miss any new CA necessitating PPI.
在这项前瞻性多中心分析中，我们旨在研究中性粒细胞/淋巴细胞比值（NLR）在接受经导管主动脉瓣置换术（TAVR）的患者永久起搏器植入（PPI）中的预测作用。
2017年2月至2021年9月，179例既往未行PPI的连续患者接受了TAVR。根据入院时是否存在传导异常（CA）（存在CA的患者n = 48例，不存在CA的患者n = 131例）将患者进一步分组。
在既往有CA的患者中，需要PPI的患者（n = 16，33%）和不需要PPI的患者之间NLR值无显著差异。相比之下，在入院时无CA的患者中，需要PPI的患者（n = 17，13%）入院时和TAVR当天测量的NLR值显著更高（分别为4.07±3.22对3.01±1.47，p = 0.025；以及10.81±7.81对5.84±3.78，p = 0.000）。多变量分析显示，TAVR当天的NLR是无CA患者PPI的独立预测因子（OR 1.294；95% CI 1.028 - 1.630；p = 0.028），但在既往有CA的患者中并非如此。ROC曲线分析显示，切点为NLR值>7.25。无CA患者的PPI时间延迟至21天。
在这项前瞻性研究中，TAVR当天较高的NLR值与既往无CA的TAVR患者PPI率增加相关。鉴于炎症是该过程的一部分，建议对所有无CA的患者将观察时间延长至至少21天，以免错过任何需要PPI的新出现的CA。
