CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC 2024 19_11-12_454-510.15836/ccar2024.454Extended AbstractValvular heart diseaseThe role of RDW/albumin and CRP/albumin ratios in long term outcomes after transcatheter aortic valve implantationhttps://orcid.org/0000-0002-3650-3297BistrovićPetra1*https://orcid.org/0000-0003-1567-8503RagužMiroslav1https://orcid.org/0000-0002-4365-9652LisičićAnte1https://orcid.org/0000-0001-8652-4523ŠipićTomislav1https://orcid.org/0000-0001-6983-1409VitlovPetra1https://orcid.org/0000-0002-7293-3972Bodrožić-Džakić PoljakTomislava1https://orcid.org/0009-0002-8409-4210BistrovićKatarina2https://orcid.org/0000-0002-4550-4056ZeljkovićIvan1https://orcid.org/0000-0001-6444-2674ManolaŠime1https://orcid.org/0000-0001-8791-4910HadžibegovićIrzal1https://orcid.org/0000-0002-2637-9691JurinIvana1Dubrava University Hospital, Zagreb, CroatiaUniversity of Zagreb, School of Medicine, Zagreb, CroatiaADDRESS FOR CORRESPONDENCE: Petra Bistrović, Klinička bolnica Dubrava, Avenija Gojka Šuška 6, HR-10000 Zagreb, Croatia. / Phone: +385-1-2903-650 / E-mail: pbistrovic@gmail.com1120241120241911-124544550110202431102024Croatian Cardiac Society2024Croatian Cardiac SocietyKEYWORDS: red cell width distributionC-reactive proteinalbumintranscatheter aortic valve implantation
Introduction: Chronic inflammation has been associated with adverse long-term outcomes in transcatheter aortic valve implantation (TAVI) patients, however no specific markers have yet been validated. (1) Previous research has shown a potential impact of RDW/albumin (RAR) and CRP/albumin (CAR) on mortality and complications in diseases such as myocardial infarction and COVID-19. Research on these parameters is scarce in chronic diseases, and so far RAR and CAR have not been studied in TAVI patients. The aim of our research is to determine if RAR and CAR have effects on survival and complications post-TAVI.
Patients and Methods: Our study included 547 patients who underwent TAVI at Dubrava University Hospital from 2012 do 2024, followed to present date. RDW, CRP and albumin were collected through routine blood samples drawn at admission. Using ROC analysis, we determined cut-off values for RDW/albumin (0.35) and CRP/albumin (0.08). Primary outcome of the study was all-cause death in follow up and secondary outcome was major adverse cardiac event (MACE) in follow up. Data was collected through in-person visits and telephone check-ups.
Results: Sociodemographic and clinical characteristics of the patients are shown in Table 1. Median RAR was 0.35 (IQR 0.32-0.40), while median CAR was 0.08 (IQR 0.03-0.17). Our analysis showed a significant difference in survival post-TAVI in patients with elevated RAR (14 vs 45 months, P 0.001; HR 2.61, 95% CI 1.79-3.82) and CAR (15 vs 23 months, P 0.017; HR 1.55, 95% CI 1.08-2.24). There was no difference in MACE during follow-up in either group.
Patient characteristics.
Variable
All patients
CRP/albumin <0.08
CRP/albumin >=0.08
P value
RDW/albumin<0.35
RDW/albumin >=0.35
P value
Age (years)
80 (76-83)
80 (77-84)
80 (75-83)
0.016*
80 (76-83)
80 (76-84)
0.308
Male
289 (51.6%)
161 (53.3%)
119 (49.4%)
0.363
147 (56,5%)
133 (47.2%)
0.029*
Diabetes mellitus
207 (37%)
106 (35.1%)
97 (40.4%)
0.204
88 (33.8%)
115 (40.9%)
0.090
Arterial hypertension
489 (87,3%)
261 (86.4%)
211 (87.6%)
0.699
230 (88.5%)
242 (85.8%)
0.359
Cerebrovascular insult
55 (9.8%)
26 (8.6%)
27 (11.3%)
0.304
25 (9.6%)
28 (10%)
0.891
COPD
68 (12.1%)
29 (9.6%)
39 (16.2%)
0.021*
27 (10.4%)
41 (14.5%)
0.145
eGFR (ml/min/1.73m2)
56.8 (41.2-73.0)
60.3 (44.8-73.5)
52.6 (36.2-71.9)
0.001*
59.7 (44.9-72.8)
53 (36.7-72.7)
0.015*
Atrial fibrillation
228 (40.7%)
111 (36.8%)
112 (46.5%)
0.022*
88 (33.8%)
135 (47.9%)
0.001*
Hemoglobin (mg/dl)
128 (116-138)
130 (119-139)
125 (112-136)
0.003*
133 (124-143)
121 (109-133)
0.001*
Hematocrit (%)
39 (35-42)
39 (36-42)
38 (34-41)
0.011*
40 (37-43)
37 (34-41)
0.001*
Platelets (10^6)
206.5 (166.5-252.0)
193 (164-230)
224 (172-279)
0.001*
207 (168-248)
206 (166-258)
0.770
CRP (mg/L)
2.9 (1.3-7.0)
1.5 (0.9-2.4)
8.00 (4.88-16.00)
0.001*
2.1 (1.0-4.5)
4.0 (1.9-11.2)
0.001*
RDW (%)
14.4 (13.7-15.7)
14.2 (13.6-15.3)
14.9 (14.1-16.2)
0.001*
13.8 (13.4-14.3)
15.7 (14.6-16.9)
0.001*
Serum albumin (g/L)
41 (39-44)
42 (40-44)
39 (37-43)
0.001*
43 (42-45)
39 (37-41)
0.001*
NTproBNP (pg/nl)
2280 (761-5508)
1452 (561-3873)
3919 (1169-8854)
0.001*
1372 (546-3569)
3164 (1015-8036)
0.001*
PAD
197 (35.2%)
103 (34.2%)
91 (37.8%)
0.393
99 (38.2%)
95 (33.7%)
0.272
Coronary artery disease
106 (20.3%)
60 (21.4%)
43 (19%)
0.505
53 (21.7%)
50 (19.2%)
0.475
LVEF (%)
55 (45-60)
58 (50-63%)
55 (40-60)
0.001*
59 (50-65)
54 (40-60)
0.001*
meanPG (mmHg)
47 (38-59)
47 (40-59)
46 (36-59)
0.2844
48 (40-59)
46 (37-58)
0.106
RDW/albumin
0.35 (0.32-0.40)
0.34 (0.32-0.37)
0.38 (0.34-0.44)
0.001*
0.32 (0.31-0.34)
0.40 (0.37-0.82)
0.001*
CRP/albumin
0.07 (0.03-0.17)
0.04 (0.02-0.06)
0.19 (0.12-0.41)
0.001*
0.05 (0.02-0.11)
0.10 (0.05-0.28)
0.001*
Numerical values are displayed as median and interquartile range. Categorical values are displayed as numbers and percentages. *Denotes statistical significance, P<0.05; COPD-Chronic obstructive pulmonary disease; eGFR-estimated glomerular filtration rate; CRP-C reactive protein; Red cell distribution width; PAD-Peripheral atherosclerotic disease; LVEF-Left ventricular ejection fraction; meanPG-Mean pressure gradient.
Conclusion: CAR and RAR are derived from parameters used in routine practice that can be easily utilized and have the potential to be used as predictive markers of survival post-TAVI. Further research is neccessary to establish exact cut-off values for TAVI patients, allowing for use in clicinal practice, which in turn could impact how we treat patients at risk.
LITERATUREHoffmannJMas-PeiroSBerkowitschABoecklingFRasperTPieszkoKInflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation.ESC Heart Fail. 2020 October;7(5):2597–610. 10.1002/ehf2.1283732639677