Association of Systemic Inflammatory Response Syndrome With Cardiovascular Events After Mitral Transcatheter Edge-to-Edge Repair

Overview

Journal J Am Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2024 Nov 11

PMID 39526356

Authors

Carlo Mannina

Akarsh Sharma

Andreina Carbone

Eduardo Bossone

Antonino Tuttolomondo

Edgar Argulian

Eric Neibart

Michael B Hadley

Jonathan Halperin

George Dangas

Samin K Sharma

Annapoorna Kini

Stamatios Lerakis

Affiliations

Soon will be listed here.

Abstract

Background: Systemic inflammatory response syndrome (SIRS) following cardiovascular interventions is associated with adverse events during hospitalization and follow-up. Mitral transcatheter edge-to-edge repair is increasingly utilized for treatment of mitral regurgitation (MR). We investigated whether SIRS following mitral transcatheter edge-to-edge repair may occur and be associated with adverse clinical outcomes.

Methods And Results: A total of 158 consecutive patients with severe MR undergoing mitral transcatheter edge-to-edge repair were studied. SIRS was defined by leukocytosis (≥12 × 10/L) and fever (≥38 °C) within 48 hours after intervention. Baseline inflammation was measured by absolute neutrophil and lymphocyte counts and neutrophil-lymphocyte ratio. The primary end point of major cardiovascular events was the composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause death. Recurrent MR at follow-up was also recorded. The mean patient age was 80.8±8.8 years. Forty-four (27.9%) developed SIRS. Neutrophil-lymphocyte ratio correlated with onset of leukocytosis and fever (=0.04). During a median follow-up of 12.5 (5.4-17.4) months, the primary end point occurred in 27 (17.1%) patients (6 myocardial infarction, 5 strokes, and 16 deaths). Patients with SIRS more often had severe MR (79.5% versus 62.7%, =0.02) at follow-up. After adjustment for pertinent variables, SIRS (HR 2.73 [95% CI, 1.08-6.86]; =0.03) was independently associated with major cardiovascular events.

Conclusions: SIRS after mitral transcatheter edge-to-edge repair is a strong independent predictor of major cardiovascular events. Closer follow-up is warranted because patients with SIRS have more severe MR at follow-up.

References

Mannina C, Kini A, Carbone A, Neibart E, Bossone E, Prandi F . Management of Systemic Inflammatory Response Syndrome After Cardiovascular Interventions. Diagnostic, Prognostic, and Therapeutic Implications. Am J Cardiol. 2024; 221:84-93. DOI: 10.1016/j.amjcard.2024.04.007. View

Luo J, Thomassen J, Nordestgaard B, Tybjaerg-Hansen A, Frikke-Schmidt R . Neutrophil counts and cardiovascular disease. Eur Heart J. 2023; 44(47):4953-4964. PMC: 10719495. DOI: 10.1093/eurheartj/ehad649. View

von Bardeleben R, Mahoney P, Morse M, Price M, Denti P, Maisano F . 1-Year Outcomes With Fourth-Generation Mitral Valve Transcatheter Edge-to-Edge Repair From the EXPAND G4 Study. JACC Cardiovasc Interv. 2023; 16(21):2600-2610. DOI: 10.1016/j.jcin.2023.09.029. View

Adamstein N, MacFadyen J, Rose L, Glynn R, Dey A, Libby P . The neutrophil-lymphocyte ratio and incident atherosclerotic events: analyses from five contemporary randomized trials. Eur Heart J. 2021; 42(9):896-903. PMC: 7936519. DOI: 10.1093/eurheartj/ehaa1034. View

Tadros R, Tang G, Barnes H, Mousavi I, Kovacic J, Faries P . Optimal Treatment of Uncomplicated Type B Aortic Dissection: JACC Review Topic of the Week. J Am Coll Cardiol. 2019; 74(11):1494-1504. DOI: 10.1016/j.jacc.2019.07.063. View

Kalinczuk L, Zielinski K, Chmielak Z, Mintz G, Dabrowski M, Pregowski J . Effect on Mortality of Systemic Thromboinflammatory Response After Transcatheter Aortic Valve Implantation. Am J Cardiol. 2019; 124(11):1741-1747. DOI: 10.1016/j.amjcard.2019.08.036. View

Lindman B, Goldstein J, Nassif M, Zajarias A, Novak E, Tibrewala A . Systemic inflammatory response syndrome after transcatheter or surgical aortic valve replacement. Heart. 2015; 101(7):537-45. PMC: 4352104. DOI: 10.1136/heartjnl-2014-307057. View

Brunkhorst F, Clark A, Forycki Z, Anker S . Pyrexia, procalcitonin, immune activation and survival in cardiogenic shock: the potential importance of bacterial translocation. Int J Cardiol. 2000; 72(1):3-10. DOI: 10.1016/s0167-5273(99)00118-7. View

Ahmed M, Andrikopoulou E, Zheng J, Ulasova E, Pat B, Kelley E . Interstitial Collagen Loss, Myocardial Remodeling, and Function in Primary Mitral Regurgitation. JACC Basic Transl Sci. 2022; 7(10):973-981. PMC: 9626893. DOI: 10.1016/j.jacbts.2022.04.014. View

10.

Norwood M, Bown M, Lloyd G, Bell P, Sayers R . The clinical value of the systemic inflammatory response syndrome (SIRS) in abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2004; 27(3):292-8. DOI: 10.1016/j.ejvs.2003.12.007. View

11.

Ladich E, Michaels M, Jones R, McDermott E, Coleman L, Komtebedde J . Pathological healing response of explanted MitraClip devices. Circulation. 2011; 123(13):1418-27. DOI: 10.1161/CIRCULATIONAHA.110.978130. View

12.

Jentzer J, Lawler P, van Diepen S, Henry T, Menon V, Baran D . Systemic Inflammatory Response Syndrome Is Associated With Increased Mortality Across the Spectrum of Shock Severity in Cardiac Intensive Care Patients. Circ Cardiovasc Qual Outcomes. 2020; 13(12):e006956. DOI: 10.1161/CIRCOUTCOMES.120.006956. View

13.

Hochman J . Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation. 2003; 107(24):2998-3002. DOI: 10.1161/01.CIR.0000075927.67673.F2. View

14.

Theroux P, Armstrong P, Mahaffey K, Hochman J, Malloy K, Rollins S . Prognostic significance of blood markers of inflammation in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty and effects of pexelizumab, a C5 inhibitor: a substudy of the COMMA trial. Eur Heart J. 2005; 26(19):1964-70. DOI: 10.1093/eurheartj/ehi292. View

15.

Baumgartner H, Hung J, Bermejo J, Chambers J, Evangelista A, Griffin B . Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009; 22(1):1-23. DOI: 10.1016/j.echo.2008.11.029. View

16.

Genereux P, Piazza N, Alu M, Nazif T, Hahn R, Pibarot P . Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol. 2021; 77(21):2717-2746. DOI: 10.1016/j.jacc.2021.02.038. View

17.

Scolari F, Ravani P, Gaggi R, Santostefano M, Rollino C, Stabellini N . The challenge of diagnosing atheroembolic renal disease clinical features and prognostic factors. Circulation 116: 298-304, 2007. Clin J Am Soc Nephrol. 2023; 3(2):317-323. DOI: 10.2215/01.CJN.0000926960.01383.34. View

18.

Adamo L, Rocha-Resende C, Prabhu S, Mann D . Reappraising the role of inflammation in heart failure. Nat Rev Cardiol. 2020; 17(5):269-285. DOI: 10.1038/s41569-019-0315-x. View

19.

McCullough P, Choi J, Feghali G, Schussler J, Stoler R, Vallabahn R . Contrast-Induced Acute Kidney Injury. J Am Coll Cardiol. 2016; 68(13):1465-1473. DOI: 10.1016/j.jacc.2016.05.099. View

20.

Schwietz T, Behjati S, Gafoor S, Seeger F, Doss M, Sievert H . Occurrence and prognostic impact of systemic inflammatory response syndrome in transfemoral and transapical aortic valve implantation with balloon- and self-expandable valves. EuroIntervention. 2014; 10(12):1468-73. DOI: 10.4244/EIJY14M06_05. View