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

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.clinicaltrials.gov ; Unique identifier: NCT00530894, NCT0134313, NCT02184442, NCT03225001, NCT0322141.

Baseline neutrophil‐to‐lymphocyte ratio and efficacy of SGLT2 inhibition with empagliflozin on cardiac remodelling

“…Increased neutrophil‐to‐lymphocyte ratio (NLR) has been identified as a biomarker of systemic inflammation and CV disease. 7 , 8 , 9 , 10 NLR is derived from the absolute neutrophil count divided by the absolute lymphocyte count. Increased absolute neutrophil count is positively associated with adverse CV events, 9 , 11 , 12 , 13 , 14 , 15 whereas lymphocytes are suggested to be anti‐atherosclerotic and lymphocyte counts are lower in patients with vascular disease.…”

Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis

“…Moreover, Ozkan et al 19 Major observational studies and randomized controlled trials have identified some independent predictors of in-hospital and longterm mortality for patients with severe AS who underwent TAVR. 1,4,6,17,26 Previously, Lauridsen et al reported that among patients undergoing TAVR, an increasing risk of exacerbation with chronic obstructive pulmonary disease was associated with increasing 1-year mortality compared with non-chronic obstructive pulmonary disease patients. 27 Besides, left ventricular ejection fraction and advanced age as independent predictors of mortality are well…”

“…Although various etiological risk factors have been defined for degenerative AS, it is an inflammatory‐based disease that shares a common pathophysiology with atherosclerosis, including calcification, deposition of lipoproteins, and chronic inflammation 1 . Since AS is the result of not only aging but also a dynamic inflammatory process, it has been suggested that inflammatory biomarkers may predict outcomes in patients receiving TAVR 2–5 . Besides, malnutrition is one of the hallmarks of frailty in elderly patients and is a harbinger of worse outcomes in elderly patients with severe AS 6 .…”

“…also a dynamic inflammatory process, it has been suggested that inflammatory biomarkers may predict outcomes in patients receiving TAVR. [2][3][4][5] Besides, malnutrition is one of the hallmarks of frailty in elderly patients and is a harbinger of worse outcomes in elderly patients with severe AS. 6 Low serum albumin level, predominantly due to malnutrition, inflammation, or cachexia, has been identified as a risk factor for the development of coronary artery disease, and there is evidence that it is associated with an increased risk of cardiovascular disease mortality in patients undergoing TAVR.…”

The neutrophil-to-lymphocyte ratio, as an emerging marker, is an important indicator predicting spontaneous reperfusion and clinical prognosis in patients with ST-segment elevation myocardial infarction

“…9 Recently, increased NLR was reported to be associated with malignant tumors, 11 inflammatory disease, 12 stoke, 13 and other diseases . In addition, both high neutrophil counts and lymphocytopenia were found to be associated with cardiovascular disease, 14,15 hence, neutrophil to lymphocyte ratio (NLR) has emerged as a new inflammation marker, which can better reflect the state of systematic inflammation.…”