Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2016; 8(7): 425-431
Published online Jul 26, 2016. doi: 10.4330/wjc.v8.i7.425
Impact of clinical and procedural factors upon C reactive protein dynamics following transcatheter aortic valve implantation
Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Antonio Colombo, Ghada W Mikhail
Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom
Neil Ruparelia, Vasileios F Panoulas, Antonio Colombo, San Raffaele Scientific Institute, 20132 Milan, Italy
Author contributions: Ruparelia N and Panoulas VF equal contributed to the paper, collected data, performed analysis, drafted manuscript; Frame A collected data, performed analysis; Malik IS and Mikhail GW drafted manuscript; Ariff B, Sutaria N, Fertleman M, Cousins J, Anderson J, Bicknell C, Chukwuemeka A and Sen S critically approved and revised manuscript; all authors confirm that they have read and approve of the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Hammersmith Hospital Institutional Review Board.
Informed consent statement: All study participants, provided informed written consent for both the procedure and on going follow-up.
Conflict-of-interest statement: The authors confirm there are no conflicts of interest.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at g.mikhail@imperial.ac.uk.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ghada W Mikhail, MD, FRCP, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, Du Cane Road, London W12 0HS, United Kingdom. g.mikhail@imperial.ac.uk
Telephone: +44-203-3132115 Fax: +44-203-3134232
Received: March 23, 2016
Peer-review started: March 24, 2016
First decision: April 15, 2016
Revised: April 26, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: July 26, 2016
Processing time: 116 Days and 11.4 Hours
Abstract

AIM: To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI).

METHODS: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure (or up to discharge). Procedural factors and 30-d safety outcomes according to the Valve Academic Research Consortium 2 definition were collected.

RESULTS: Following TAVI, CRP significantly increased reaching a peak on day 3 of 87.6 ± 5.5 mg/dL, P < 0.001. Patients who developed clinical signs and symptoms of sepsis had significantly increased levels of CRP (P < 0.001). The presence of diabetes mellitus was associated with a significantly higher peak CRP level at day 3 (78.4 ± 3.2 vs 92.2 ± 4.4, P < 0.001). There was no difference in peak CRP release following balloon-expandable or self-expandable TAVI implantation (94.8 ± 9.1 vs 81.9 ± 6.9, P = 0.34) or if post-dilatation was required (86.9 ± 6.3 vs 96.6 ± 5.3, P = 0.42), however, when pre-TAVI balloon aortic valvuloplasty was performed this resulted in a significant increase in the peak CRP (110.1 ± 8.9 vs 51.6 ± 3.7, P < 0.001). The development of a major vascular complication did result in a significantly increased maximal CRP release (153.7 ± 11.9 vs 83.3 ± 7.4, P = 0.02) and there was a trend toward a higher peak CRP following major/life-threatening bleeding (113.2 ± 9.3 vs 82.7 ± 7.5, P = 0.12) although this did not reach statistical significance. CRP was not found to be a predictor of 30-d mortality on univariate analysis.

CONCLUSION: Careful attention should be paid to baseline clinical characteristics and procedural factors when interpreting CRP following TAVI to determine their future management.

Keywords: Aortic stenosis; Transcatheter aortic valve implantation; C reactive protein; Inflammation

Core tip: Transcatheter aortic valve implantation (TAVI) results in increases in serum C reactive protein (CRP) levels reaching a peak at day 3 in all patients. CRP increase is further increased in patients with diabetes mellitus, those that underwent pre-TAVI balloon aortic valvuloplasty and patients that suffered major vascular complications. In addition to the bedside evaluation of patients, careful attention should be paid to baseline clinical characteristics and procedural factors when interpreting CRP to aid in the management and risk assessment of patients following TAVI.