Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia. Electronic address: https://www.twitter.com/RohanNavani.
Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Atherothrombosis and Vascular Biology Laboratory, Baker Heart & Diabetes Institute, Melbourne, Vic, Australia; School of Translational Medicine, Monash University, Melbourne, Vic, Australia.
Heart Lung Circ. 2024 Sep;33(9):1340-1347. doi: 10.1016/j.hlc.2024.03.013. Epub 2024 Jun 6.
BACKGROUND: Aortic stenosis has recently been characterised as having an inflammatory aetiology, beyond the traditional degenerative model. Recruitment of monocytes has been associated with inflammation contributing to progression of calcific aortic-valve disease. Prior research has demonstrated that pre-procedure inflammatory biomarkers do not consistently discriminate poorer outcomes in those with aortic stenosis. It remains, however, unclear if postprocedure inflammatory biomarkers, which are influenced by intraprocedural pro-inflammatory insults, can predict major adverse cardiovascular events (MACE) post transcatheter aortic valve implantation (TAVI). METHOD: All patients with postprocedure monocyte levels undergoing transcatheter aortic valve implantation at The Alfred Hospital, Melbourne, Australia (2008-2019) were included. The highest monocyte count from postprocedure days 1 to 3 was used. Patients were divided into "high" or "low" postprocedure monocyte count groups using the Youden Index. The incidence of 30-day MACE a composite of stroke, acute myocardial infarction, and death) was then compared. RESULTS: In total, 472 patients were included (54% men, median age 84 years). Fourteen (14) patients (3%) suffered a 30-day MACE. Those with high postprocedure monocyte count were more likely to: be hypertensive (p=0.049); have a higher Society of Thoracic Surgeons risk score (p=0.032); and, undergo non-transfemoral access (p=0.018). A high (≥0.975) postprocedure monocyte count was significantly associated with 30-day MACE (odds ratio [OR] 1.16 for each 0.1 increase in monocyte, p=0.025). This association remained present on multivariable analysis adjusted for age, sex, Society of Thoracic Surgeons risk score, and self-expanding valve prosthesis type (OR 1.17, p=0.028). CONCLUSIONS: The association between postprocedure monocytosis and 30-day MACE suggests that minimising peri-procedural inflammatory insults may improve outcomes. This inexpensive and readily available biomarker may also aid in tailored risk stratification for patients.
背景：主动脉瓣狭窄最近被认为具有炎症病因，超出了传统的退行性模型。单核细胞的募集与炎症有关，炎症导致钙化为主动脉瓣疾病的进展。先前的研究表明，术前炎症生物标志物并不能一致地区分主动脉瓣狭窄患者的预后较差。然而，仍然不清楚术后炎症生物标志物是否可以预测经导管主动脉瓣植入术（TAVI）后主要不良心血管事件（MACE）。 方法：纳入 2008 年至 2019 年在澳大利亚墨尔本阿尔弗雷德医院接受经导管主动脉瓣植入术后单核细胞水平升高的所有患者。使用术后第 1 至 3 天的最高单核细胞计数。使用 Youden 指数将患者分为“高”或“低”术后单核细胞计数组。然后比较 30 天 MACE（包括中风、急性心肌梗死和死亡的复合事件）的发生率。 结果：共有 472 名患者入选（54%为男性，中位年龄为 84 岁）。14 名（14%）患者在 30 天内发生 MACE。术后单核细胞计数较高的患者更有可能：患有高血压（p=0.049）；具有更高的胸外科医师协会风险评分（p=0.032）；并且接受非经股动脉入路（p=0.018）。术后单核细胞计数较高（≥0.975）与 30 天 MACE 显著相关（单核细胞每增加 0.1，比值比[OR]为 1.16，p=0.025）。在校正年龄、性别、胸外科医师协会风险评分和自膨式瓣膜假体类型后，这种相关性仍然存在（OR 1.17，p=0.028）。 结论：术后单核细胞增多症与 30 天 MACE 之间的关联表明，最大限度地减少围手术期炎症损伤可能会改善预后。这种廉价且易于获得的生物标志物也可能有助于对患者进行针对性的风险分层。
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