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How does inflammation influence left ventricular function after TAVI?
Aims: Transcatheter aortic valve implantation (TAVI) is an emerging treatment option for inoperable or high-risk patients. After the procedure, most patients show significant improvement of left ventricular function. However, the recovery of the left ventricle is not immediately observed in all patients, while in some there is a temporary deterioration. Furthermore, elevated levels of CRP and white blood cells (WBC) are observed in some patients after TAVI. Elevated CRP has been associated with reduced left ventricular function. Therefore, we hypothesised that inflammatory parameters may influence left ventricular recovery after TAVI.
Methods and results: Data from 76 consecutive patients (80.37±5.36 years, 33 males (48.8%), AVA: 0.63±0.15 cm2) who underwent TAVI were evaluated from an existing database. Blood samples were obtained before TAVI, three hours and daily for five days after the procedure. CRP as well as WBC were recorded. In addition, transthoracic echocardiogram was performed and obtained before TAVI and daily for five days after the procedure. Patients were separated into three groups according to left ventricle improvement (improved, declined, unaffected). From these groups, LVEF improved in 29 patients (39.7%), declined in 11 patients (15.1%) and remained unaffected in 33 patients (45.2%). We performed the ANOVA statistical test among the three groups and found significant differences between them for CRPmax (p<0.01) and WBC1st day after (p<0.01). In particular, post hoc analysis showed higher levels of CRPmax (70.2±49.28 vs. 120±22.36, p<0.01) and WBC1st day after (16,333±4,685 vs. 11,748±3,512, p<0.01) in patients with declined LVEF compared to those with unaffected LVEF, respectively. Similarly, post hoc analysis recorded greater value for CRPmax (120±22.36 vs. 61.99±36.9, p<0.01) and WBC1st day after (16,528±4,890 vs. 10,800±2,687, p<0.01) in patients with declined LVEF when compared with those with improved LVEF.
Conclusions: In conclusion, inflammation as detected by simple indices such as WBC and CRP may be associated with left ventricular function after TAVI.
