Jesselson Integrated Heart Center, Shaare Zedek Medical Center Jerusalem and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Department of Cardiology, Barzilai Medical Center, Ashkelon and Ben-Gurion University of the Negev, Ashkelon, Israel.
BMC Cardiovasc Disord. 2024 Oct 14;24(1):555. doi: 10.1186/s12872-024-04246-7.
Platelets play a key role in the natural history of aortic stenosis (AS) and after transcatheter aortic valve implantation (TAVI). An echo-based staging system stratifies patients with severe AS into 5 groups according to the associated cardiac damage phenotype. We aimed to correlate these AS stages with platelet indices in post-TAVI patients.
Patients with severe AS who underwent TAVI and were admitted to intensive cardiac care unit (ICCU) were prospectively identified and divided into 5 groups according to extra-valvular cardiac damage [no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4)]. Baseline characteristics and complete blood count including mean platelet volume (MPV) and immature platelet fraction (IPF) were collected within 2 h after the procedure and analyzed in relation to aortic stenosis staging.
A total of 220 patients were included. The mean age was 81 years old and 112 (50.9%) were female. Two (1%) patients were classified in stage 0; 34 (15%) in stage 1; 48 (22%) in stage 2; 49 (22%) in stage 3 and 87 (40%) in stage 4. Higher mean MPV values were correlated with higher AS staging (10.8 fL, 11 fL, 11.3 fL and 10.8 fL in stages 1, 2, 3 and 4, respectively, P = 0.02) as well as lower hemoglobin values (12 mg/dl, 11.6 mg/dl, 11 mg/dl and 11.3 mg/dl in stages 1, 2, 3 and 4, respectively P = 0.04). Mean IPF values were 5.3%, 5.58%, 5.57% and 4.83% in stage 1, 2, 3 and 4, respectively (P = 0.4). In a multivariate logistic regression model only MPV (OR = 2.6, P = 0.03) and body mass index (BMI) (OR = 1.17, P = 0.004) were correlated with higher staging (0-3) of AS.
Although IPF and MPV levels increased in stages 0-3, there was a decrease in indices in stage 4, (probably due to bone marrow dysfunction) in this end-stage population. Higher levels of MPV and lower levels of hemoglobin were independently correlated with higher stages (0-3) of AS.
血小板在主动脉瓣狭窄（AS）的自然病史和经导管主动脉瓣置换术（TAVI）后发挥着关键作用。一个基于超声的分期系统根据相关的心脏损伤表型将严重 AS 患者分为 5 组。我们旨在将这些 AS 分期与 TAVI 后患者的血小板指数相关联。
前瞻性地识别接受 TAVI 并入住重症监护心脏病房（ICCU）的严重 AS 患者，并根据瓣外心脏损伤将其分为 5 组[无瓣外心脏损伤（阶段 0）、左心室损伤（阶段 1）、左心房或二尖瓣损伤（阶段 2）、肺血管或三尖瓣损伤（阶段 3）或右心室损伤（阶段 4）]。在手术后 2 小时内收集基线特征和全血细胞计数，包括平均血小板体积（MPV）和未成熟血小板分数（IPF），并分析其与主动脉瓣狭窄分期的关系。
共纳入 220 例患者。平均年龄为 81 岁，112 例（50.9%）为女性。有 2 例（1%）患者被归类为 0 期；34 例（15%）为 1 期；48 例（22%）为 2 期；49 例（22%）为 3 期，87 例（40%）为 4 期。较高的平均 MPV 值与较高的 AS 分期相关（1 期、2 期、3 期和 4 期的平均 MPV 值分别为 10.8 fL、11 fL、11.3 fL 和 10.8 fL，P=0.02），血红蛋白值较低（1 期、2 期、3 期和 4 期的平均血红蛋白值分别为 12 mg/dl、11.6 mg/dl、11 mg/dl 和 11.3 mg/dl，P=0.04）。1 期、2 期、3 期和 4 期的平均 IPF 值分别为 5.3%、5.58%、5.57%和 4.83%（P=0.4）。在多变量逻辑回归模型中，只有 MPV（OR=2.6，P=0.03）和体重指数（BMI）（OR=1.17，P=0.004）与较高的 AS 分期（0-3）相关。
尽管 0-3 期的 IPF 和 MPV 水平升高，但在终末期人群中，4 期（可能由于骨髓功能障碍）的指数下降。较高的 MPV 和较低的血红蛋白水平与较高的 AS 分期（0-3）独立相关。
