Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation
Abstract Aims Systemic inflammatory response, identified by increased total leucocyte counts, was shown to be a strong predictor of mortality after transcatheter aortic valve implantation (TAVI). Yet the mechanisms of inflammation‐associated poor outcome after TAVI are unclear. Therefore, the presen...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.12837 |
| _version_ | 1818621619993575424 |
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| author | Jedrzej Hoffmann Silvia Mas‐Peiro Alexander Berkowitsch Felicitas Boeckling Tina Rasper Konrad Pieszko Roberta De Rosa Jarosław Hiczkiewicz Paweł Burchardt Stephan Fichtlscherer Andreas M. Zeiher Stefanie Dimmeler Mariuca Vasa Nicotera |
| author_facet | Jedrzej Hoffmann Silvia Mas‐Peiro Alexander Berkowitsch Felicitas Boeckling Tina Rasper Konrad Pieszko Roberta De Rosa Jarosław Hiczkiewicz Paweł Burchardt Stephan Fichtlscherer Andreas M. Zeiher Stefanie Dimmeler Mariuca Vasa Nicotera |
| author_sort | Jedrzej Hoffmann |
| collection | DOAJ |
| description | Abstract Aims Systemic inflammatory response, identified by increased total leucocyte counts, was shown to be a strong predictor of mortality after transcatheter aortic valve implantation (TAVI). Yet the mechanisms of inflammation‐associated poor outcome after TAVI are unclear. Therefore, the present study aimed at investigating individual inflammatory signatures and functional heterogeneity of circulating myeloid and T‐lymphocyte subsets and their impact on 1 year survival in a single‐centre cohort of patients with severe aortic stenosis undergoing TAVI. Methods and results One hundred twenty‐nine consecutive patients with severe symptomatic aortic stenosis admitted for transfemoral TAVI were included. Blood samples were obtained at baseline, immediately after, and 24 h and 3 days after TAVI, and these were analysed for inflammatory and cardiac biomarkers. Myeloid and T‐lymphocyte subsets were measured using flow cytometry. The inflammatory parameters were first analysed as continuous variables; and in case of association with outcome and area under receiver operating characteristic (ROC) curve (AUC) ≥ 0.6, the values were dichotomized using optimal cut‐off points. Several baseline inflammatory parameters, including high‐sensitivity C‐reactive protein (hsCRP; HR = 1.37, 95% CI: 1.15–1.63; P < 0.0001) and IL‐6 (HR = 1.02, 95% CI: 1.01–1.03; P = 0.003), lower counts of Th2 (HR = 0.95, 95% CI: 0.91–0.99; P = 0.009), and increased percentages of Th17 cells (HR = 1.19, 95% CI: 1.02–1.38; P = 0.024) were associated with 12 month all‐cause mortality. Among postprocedural parameters, only increased post‐TAVI counts of non‐classical monocytes immediately after TAVI were predictive of outcome (HR = 1.03, 95% CI: 1.01–1.05; P = 0.003). The occurrence of SIRS criteria within 48 h post‐TAVI showed no significant association with 12 month mortality (HR = 0.57, 95% CI: 0.13–2.43, P = 0.45). In multivariate analysis of discrete or dichotomized clinical and inflammatory variables, the presence of diabetes mellitus (HR = 3.50; 95% CI: 1.42–8.62; P = 0.006), low left ventricular (LV) ejection fraction (HR = 3.16; 95% CI: 1.35–7.39; P = 0.008), increased baseline hsCRP (HR = 5.22; 95% CI: 2.09–13.01; P < 0.0001), and low baseline Th2 cell counts (HR = 8.83; 95% CI: 3.02–25.80) were significant predictors of death. The prognostic value of the linear prediction score calculated of these parameters was superior to the Society of Thoracic Surgeons score (AUC: 0.88; 95% CI: 0.78–0.99 vs. 0.75; 95% CI: 0.64–0.86, respectively; P = 0.036). Finally, when analysing LV remodelling outcomes, ROC curve analysis revealed that low numbers of Tregs (P = 0.017; AUC: 0.69) and increased Th17/Treg ratio (P = 0.012; AUC: 0.70) were predictive of adverse remodelling after TAVI. Conclusions Our findings demonstrate an association of specific pre‐existing inflammatory phenotypes with increased mortality and adverse LV remodelling after TAVI. Distinct monocyte and T‐cell signatures might provide additive biomarkers to improve pre‐procedural risk stratification in patients referred to TAVI for severe aortic stenosis. |
| first_indexed | 2024-12-16T18:12:10Z |
| format | Article |
| id | doaj.art-ef0109c4ef5b40f1ab4d6c798cc885bd |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-16T18:12:10Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-ef0109c4ef5b40f1ab4d6c798cc885bd2022-12-21T22:21:44ZengWileyESC Heart Failure2055-58222020-10-01752597261010.1002/ehf2.12837Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantationJedrzej Hoffmann0Silvia Mas‐Peiro1Alexander Berkowitsch2Felicitas Boeckling3Tina Rasper4Konrad Pieszko5Roberta De Rosa6Jarosław Hiczkiewicz7Paweł Burchardt8Stephan Fichtlscherer9Andreas M. Zeiher10Stefanie Dimmeler11Mariuca Vasa Nicotera12Department of Cardiology, Center of Internal Medicine Goethe University Frankfurt Frankfurt GermanyDepartment of Cardiology, Center of Internal Medicine Goethe University Frankfurt Frankfurt GermanyDepartment of Cardiology, Center of Internal Medicine Goethe University Frankfurt Frankfurt GermanyDepartment of Cardiology, Center of Internal Medicine Goethe University Frankfurt Frankfurt GermanyInstitute of Cardiovascular Regeneration, Center of Molecular Medicine Goethe University Frankfurt Frankfurt GermanyDepartment of Cardiology Nowa Sól Multidisciplinary Hospital Nowa Sól PolandDepartment of Cardiology, Center of Internal Medicine Goethe University Frankfurt Frankfurt GermanyDepartment of Cardiology Nowa Sól Multidisciplinary Hospital Nowa Sól PolandBiology of Lipid Disorders Department Poznan University of Medical Sciences Poznań PolandDepartment of Cardiology, Center of Internal Medicine Goethe University Frankfurt Frankfurt GermanyDepartment of Cardiology, Center of Internal Medicine Goethe University Frankfurt Frankfurt GermanyGerman Center for Cardiovascular Research (DZHK) Partner site Rhine‐Main GermanyDepartment of Cardiology, Center of Internal Medicine Goethe University Frankfurt Frankfurt GermanyAbstract Aims Systemic inflammatory response, identified by increased total leucocyte counts, was shown to be a strong predictor of mortality after transcatheter aortic valve implantation (TAVI). Yet the mechanisms of inflammation‐associated poor outcome after TAVI are unclear. Therefore, the present study aimed at investigating individual inflammatory signatures and functional heterogeneity of circulating myeloid and T‐lymphocyte subsets and their impact on 1 year survival in a single‐centre cohort of patients with severe aortic stenosis undergoing TAVI. Methods and results One hundred twenty‐nine consecutive patients with severe symptomatic aortic stenosis admitted for transfemoral TAVI were included. Blood samples were obtained at baseline, immediately after, and 24 h and 3 days after TAVI, and these were analysed for inflammatory and cardiac biomarkers. Myeloid and T‐lymphocyte subsets were measured using flow cytometry. The inflammatory parameters were first analysed as continuous variables; and in case of association with outcome and area under receiver operating characteristic (ROC) curve (AUC) ≥ 0.6, the values were dichotomized using optimal cut‐off points. Several baseline inflammatory parameters, including high‐sensitivity C‐reactive protein (hsCRP; HR = 1.37, 95% CI: 1.15–1.63; P < 0.0001) and IL‐6 (HR = 1.02, 95% CI: 1.01–1.03; P = 0.003), lower counts of Th2 (HR = 0.95, 95% CI: 0.91–0.99; P = 0.009), and increased percentages of Th17 cells (HR = 1.19, 95% CI: 1.02–1.38; P = 0.024) were associated with 12 month all‐cause mortality. Among postprocedural parameters, only increased post‐TAVI counts of non‐classical monocytes immediately after TAVI were predictive of outcome (HR = 1.03, 95% CI: 1.01–1.05; P = 0.003). The occurrence of SIRS criteria within 48 h post‐TAVI showed no significant association with 12 month mortality (HR = 0.57, 95% CI: 0.13–2.43, P = 0.45). In multivariate analysis of discrete or dichotomized clinical and inflammatory variables, the presence of diabetes mellitus (HR = 3.50; 95% CI: 1.42–8.62; P = 0.006), low left ventricular (LV) ejection fraction (HR = 3.16; 95% CI: 1.35–7.39; P = 0.008), increased baseline hsCRP (HR = 5.22; 95% CI: 2.09–13.01; P < 0.0001), and low baseline Th2 cell counts (HR = 8.83; 95% CI: 3.02–25.80) were significant predictors of death. The prognostic value of the linear prediction score calculated of these parameters was superior to the Society of Thoracic Surgeons score (AUC: 0.88; 95% CI: 0.78–0.99 vs. 0.75; 95% CI: 0.64–0.86, respectively; P = 0.036). Finally, when analysing LV remodelling outcomes, ROC curve analysis revealed that low numbers of Tregs (P = 0.017; AUC: 0.69) and increased Th17/Treg ratio (P = 0.012; AUC: 0.70) were predictive of adverse remodelling after TAVI. Conclusions Our findings demonstrate an association of specific pre‐existing inflammatory phenotypes with increased mortality and adverse LV remodelling after TAVI. Distinct monocyte and T‐cell signatures might provide additive biomarkers to improve pre‐procedural risk stratification in patients referred to TAVI for severe aortic stenosis.https://doi.org/10.1002/ehf2.12837InflammationT cellsMonocytesAortic stenosisTAVI |
| spellingShingle | Jedrzej Hoffmann Silvia Mas‐Peiro Alexander Berkowitsch Felicitas Boeckling Tina Rasper Konrad Pieszko Roberta De Rosa Jarosław Hiczkiewicz Paweł Burchardt Stephan Fichtlscherer Andreas M. Zeiher Stefanie Dimmeler Mariuca Vasa Nicotera Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation ESC Heart Failure Inflammation T cells Monocytes Aortic stenosis TAVI |
| title | Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation |
| title_full | Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation |
| title_fullStr | Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation |
| title_full_unstemmed | Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation |
| title_short | Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation |
| title_sort | inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation |
| topic | Inflammation T cells Monocytes Aortic stenosis TAVI |
| url | https://doi.org/10.1002/ehf2.12837 |
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