术前中性粒细胞与淋巴细胞比值：经导管主动脉瓣植入术后自膨胀式与球囊扩张式瓣膜队列中永久起搏器植入的新型预测指标。

Preprocedural neutrophil-to-lymphocyte ratio: A novel predictor of permanent pacemaker implantation in self-expandable vs balloon-expandable valve cohorts following transcatheter aortic valve implantation.

作者信息

Khadija Haitham Abu, Alnees Mohammad, Ayyad Omar, Gandelman Gera, Sella Gal, Hamdeh Nizar Abu, Haim Amir, Hamdan Yazan, Kirzhner Alena, Darwish Abdalaziz, Najajra Duha, Schiller Tal, Blatt Alex, George Jacob

机构信息

Department of Cardiology, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

Harvard Medical School, Postgraduate Medical Education, Global Clinical Scholer Research Training Program, Boston, Massachusetts.

出版信息

Heart Rhythm O2. 2025 Mar 11;6(6):766-780. doi: 10.1016/j.hroo.2025.03.003. eCollection 2025 Jun.

DOI:10.1016/j.hroo.2025.03.003

PMID:40717860

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12287960/

Abstract

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is the preferred treatment for severe aortic stenosis. This study examines the neutrophil-lymphocyte ratio (NLR) as a predictor of permanent pacemaker implantation (PPI) outcomes, comparing self-expandable valves (SEVs) and balloon-expandable valves (BEVs).

OBJECTIVE

This study aims to evaluate the effectiveness of the NLR in predicting PPI outcomes in patients undergoing TAVI with SEVs and BEVs.

METHODS

This retrospective cohort study at Kaplan Medical Center analyzed 305 patients with severe symptomatic aortic stenosis referred for TAVI from January 2010 to December 2019. Data on baseline characteristics, laboratory results, and clinical outcomes were collected, including NLR and PPI rates. Two logistic regression models were developed to identify predictors of TAVI-PPI outcomes for SEV and BEV cohorts.

RESULTS

In the SEV cohort, 59 of 199 patients (29.6%) required PPI, compared with 15 of 106 patients (14.2%) in the BEV cohort. The receiver operating characteristic (ROC) curve for SEV showed an area under the curve (AUC) of 0.70, indicating predictive ability of the NLR for TAVI-PPI outcomes. The BEV cohort had a lower AUC of 0.40 ( = .03). In the SEV model, significant predictors included NLR (odds ratio [OR]: 1.146, =.040) and total protein levels (OR: 0.012, = .029). In the BEV model, the QTc interval was significant (OR: 1.023, = .018).

CONCLUSION

The NLR significantly predicts permanent pacemaker implantation after TAVI, especially for SEVs, but less for BEVs.

摘要

背景

经导管主动脉瓣植入术（TAVI）是重度主动脉瓣狭窄的首选治疗方法。本研究探讨中性粒细胞与淋巴细胞比值（NLR）作为永久起搏器植入（PPI）结果的预测指标，并比较自膨胀瓣膜（SEV）和球囊扩张瓣膜（BEV）。

目的

本研究旨在评估NLR对接受TAVI的SEV和BEV患者PPI结果的预测有效性。

方法

这项在卡普兰医疗中心进行的回顾性队列研究分析了2010年1月至2019年12月期间因TAVI就诊的305例重度症状性主动脉瓣狭窄患者。收集了基线特征、实验室检查结果和临床结局数据，包括NLR和PPI发生率。建立了两个逻辑回归模型，以确定SEV和BEV队列中TAVI-PPI结果的预测因素。

结果

在SEV队列中，199例患者中有59例（29.6%）需要PPI，而在BEV队列中，106例患者中有15例（14.2%）需要PPI。SEV的受试者工作特征（ROC）曲线显示曲线下面积（AUC）为0.70，表明NLR对TAVI-PPI结果具有预测能力。BEV队列的AUC较低，为0.40（P = 0.03）。在SEV模型中，显著预测因素包括NLR（比值比[OR]：1.146，P = 0.040）和总蛋白水平（OR：0.012，P = 0.029）。在BEV模型中，QTc间期具有显著性（OR：1.023，P = 0.018）。