Neutrophil-to-Lymphocyte Ratios in Patients Undergoing Aortic Valve Replacement: The PARTNER Trials and Registries

• Type of Material: Article
• Authors: Bahira Shahim, Cardiovascular Research Foundation; Björn Redfors, Cardiovascular Research Foundation; Brian R Lindman, Vanderbilt University; Shmuel Chen, Cardiovascular Research Foundation; Torsten Dahlen, Karolinska Institutet; Tamim Nazif, Columbia University; Samir Kapadia, Cleveland Clinic; Zachary M Gertz, Virginia Commonwealth University; Aaron C Crowley, Cardiovascular Research Foundation; Ditian Li, Cardiovascular Research Foundation; Vinod Thourani, Emory University; Susheel K Kodali, Columbia University; Alan Zajarias, Washington Univ; Vasilis Babaliaros, Emory University; Robert Guyton, Emory University; Sammy Elmariah, Massachussetts General Hospital; Howard C Herrmann, University of Pennsylvania; David Cohen, Emory University; Michael J Mack, Baylor Scott & White Health The Heart Hospital Plano; Craig R Smith, Columbia University; Martin B Leon, Cardiovascular Research Foundation; Isaac George, Columbia University
• Language: English
• Date: 2022-06-07
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.121.024091
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 11
• Issue: 11
• Start Page: e024091
• End Page: e024091
• Grant/Funding Information: The PARTNER trial was funded by Edwards Lifesciences, California.
• Keywords: NLR; MECHANISMS; aortic stenosis; surgical aortic valve replacement; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; MORTALITY; transcatheter aortic valve replacement; Science & Technology; neutrophil-to-lymphocyte ratio; TRANSCATHETER; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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; P<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; P<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.clini​caltr​ials.gov; Unique identifier: NCT00530894, NCT0134313, NCT02184442, NCT03225001, NCT0322141.