Advertisement

Additive Value of High-Density Lipoprotein Cholesterol and C-Reactive Protein Level Assessment for Prediction of 2-year Mortality After Transcatheter Aortic Valve Implantation

      Available prediction models are inaccurate in elderly who underwent transcatheter aortic valve implantation (TAVI). The aim of present study was to analyze the separate and combined prognostic values of baseline HDL-C and C-reactive protein (CRP) levels in patients treated successfully with TAVI who had complete 2-year follow-up. We analyzed 334 patients treated with TAVI from 01/2010 to 07/2017 who had measurements of HDL-C and CRP on admission or during qualification for the procedure. Baseline HDL-C ≤46 mg/dl (areas under the curve [AUC] = 0.657) and CRP ≥0.20 mg/dl (AUC = 0.634) were predictive of 2-year mortality. After stratification with both cutoffs, patients with low HDL-C and concomitant high CRP most often had LVEF ≤50% and were high risk as per EuroSCORE II. Those with isolated CRP elevation had the lowest frequency of LVEF ≤50%, but more sarcopenia (based on psoas muscle area). After adjustment in the multivariate analysis for other identified predictors including EuroSCORE II and statin therapy, isolated HDL-C ≤46 mg/dl (identified in 40 patients) and isolated CRP ≥0.20 mg/dl (n = 109) were both independent predictors of 2-year mortality (hazard ratio [HR] = 2.92 and HR = 2.42, respectively) compared with patients with both markers within established cutoffs (n = 105) who had the lowest 2-year mortality (9.5%). Patients with both markers exceeding cutoffs (n = 80) had the highest risk (HR = 4.53) with 2-year mortality of 42.5%. High CRP was associated with increased mortality within the first year of follow-up, whereas low HDL-C increased mortality in the second year. The combination of both markers with EuroSCORE II enhanced mortality prediction (AUC = 0.697). In conclusion, low baseline HDL-C and high CRP jointly contribute to the prediction of increased all-cause mortality after TAVI.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Afilalo J
        • Lauck S
        • Kim DH
        • Lefèvre T
        • Piazza N
        • Lachapelle K
        • Martucci G
        • Lamy A
        • Labinaz M
        • Peterson MD
        • Arora RC
        • Noiseux N
        • Rassi A
        • Palacios IF
        • Généreux P
        • Lindman BR
        • Asgar AW
        • Kim CA
        • Trnkus A
        • Morais JA
        • Langlois Y
        • Rudski LG
        • Morin JF
        • Popma JJ
        • Webb JG
        • Perrault LP
        Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study.
        J Am Coll Cardiol. 2017; 70: 689-700
        • Takagi H
        • Hari Y
        • Kawai N
        • Ando T
        • ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
        Meta-analysis of the prognostic value of psoas-muscle area on mortality in patients undergoing transcatheter aortic valve implantation.
        Am J Cardiol. 2018; 122: 1394-1400
        • Ravnskov U
        • Diamond DM
        • Hama R
        • Hamazaki T
        • Hammarskjöld B
        • Hynes N
        • Kendrick M
        • Langsjoen PH
        • Malhotra A
        • Mascitelli L
        • McCully KS
        • Ogushi Y
        • Okuyama H
        • Rosch PJ
        • Schersten T
        • Sultan S
        • Sundberg R
        Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review.
        BMJ Open. 2016; 6e010401
        • Zhao Q
        • Li J
        • Yang J
        • Li R
        Association of total cholesterol and HDL-C levels and outcome in coronary heart disease patients with heart failure.
        Medicine (Baltimore). 2017; 96: e6094
        • Yelgeç NS
        • Emre A
        Prognostic value of lipid levels in short-term outcome after TAVI.
        Herz. 2019; ([Epub ahead of print])https://doi.org/10.1007/s00059-019-4826-3
        • Hioki H
        • Watanabe Y
        • Kozuma K
        • Yamamoto M
        • Naganuma T
        • Araki M
        • Tada N
        • Shirai S
        • Yamanaka F
        • Higashimori A
        • Mizutani K
        • Tabata M
        • Takagi K
        • Ueno H
        • Hayashida K
        • OCEAN-TAVI Investigators
        Effect of serum C-Reactive Protein level on admission to predict mortality after transcatheter aortic valve implantation.
        Am J Cardiol. 2018; 122: 294-301
        • Kim KI
        • Oh SW
        • Ahn S
        • Heo NJ
        • Kim S
        • Chin HJ
        • Na KY
        • Chae DW
        • Kim CH
        • Kim S
        CRP level and HDL cholesterol concentration jointly predict mortality in a Korean population.
        Am J Med. 2012; 125 (787-795.e4)
        • Bilhorn KR1
        • Luo Y
        • Lee BT
        • Wong ND
        High-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and cardiovascular disease in United States adults.
        Am J Cardiol. 2012; 110: 1464-1467
        • Cabana VG
        • Siegel JN
        • Sabesin SM
        Effects of the acute phase response on the concentration and density distribution of plasma lipids and apolipoproteins.
        J Lipid Res. 1989; 30: 39-49
        • Lv W
        • Li S
        • Liao Y
        • Zhao Z
        • Che G
        • Chen M
        • Feng Y
        The 'obesity paradox' does exist in patients undergoing transcatheter aortic valve implantation for aortic stenosis: a systematic review and meta-analysis.
        Interact Cardiovasc Thorac Surg. 2017; 25: 633-642
        • Lindman BR
        • Otto CM
        • Douglas PS
        • Hahn RT
        • Elmariah S
        • Weissman NJ
        • Stewart WJ
        • Ayele GM
        • Zhang F
        • Zajarias A
        • Maniar HS
        • Jilaihawi H
        • Blackstone E
        • Chinnakondepalli KM
        • Tuzcu EM
        • Leon MB
        • Pibarot P
        Blood pressure and arterial load after transcatheter aortic valve replacement for aortic stenosis.
        Circ Cardiovasc Imaging. 2017; 10: e006308
        • Reddy VS
        • Bui QT
        • Jacobs JR
        • Begelman SM
        • Miller DP
        • French WJ
        • Investigators of National Registry of Myocardial Infarction (NRMI) 4b–5
        Relationship between serum low-density lipoprotein cholesterol and in-hospital mortality following acute myocardial infarction (the lipid paradox).
        Am J Cardiol. 2015; 115: 557-562
        • Liang Y
        • Vetrano DL
        • Qiu C
        Serum total cholesterol and risk of cardiovascular and non-cardiovascular mortality in old age: a population-based study.
        BMC Geriatr. 2017; 17: 294
        • Stundl A
        • Busse L
        • Leimkühler P
        • Weber M
        • Zur B
        • Mellert F
        • Grube E
        • Nickenig G
        • Werner N
        • Sinning JM
        Combination of high-sensitivity C-reactive protein with logistic EuroSCORE improves risk stratification in patients undergoing TAVI.
        Eurointervention. 2018; 14: 629-636
        • Tonelli M
        • Sacks F
        • Pfeffer M
        • Jhangri GS
        • Curhan G
        • Cholesterol and Recurrent Events (CARE) Trial Investigators
        Biomarkers of inflammation and progression of chronic kidney disease.
        Kidney Int. 2005; 68: 237-245
        • Sousa AC
        • Zunzunegui MV
        • Li A
        • Phillips SP
        • Guralnik JM
        • Guerra RO
        Association between C-reactive protein and physical performance in older populations: results from the International Mobility in Aging Study (IMIAS).
        Age Ageing. 2016; 45: 274-280
        • Gan WQ
        • Man SF
        • Senthilselvan A
        • Sin DD
        Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis.
        Thorax. 2004; 59: 574-580
        • Vilalta V
        • Asmarats L
        • Ferreira-Neto AN
        • Maes F
        • de Freitas Campos Guimarães L
        • Couture T
        • Paradis JM
        • Mohammadi S
        • Dumont E
        • Kalavrouziotis D
        • Delarochellière R
        • Rodés-Cabau J
        Incidence, clinical characteristics, and impact of acute coronary syndrome following transcatheter aortic valve replacement.
        JACC Cardiovasc Interv. 2018; 11: 2523-2533
        • Saia F
        • Latib A
        • Ciuca C
        • Gasparetto V
        • Napodano M
        • Sticchi A
        • Anderlucci L
        • Marrozzini C
        • Naganuma T
        • Alfieri O
        • Facchin M
        • Hoxha B
        • Moretti C
        • Marzocchi A
        • Colombo A
        • Tarantini G
        Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement.
        Am Heart J. 2014; 168: 798-806
        • Jafri H
        • Alsheikh-Ali AA
        • Karas RH
        Baseline and on-treatment high-density lipoprotein cholesterol and the risk of cancer in randomized controlled trials of lipid-altering therapy.
        J Am Coll Cardiol. 2010; 55: 2846-2854
        • Li Y
        • Zhong X
        • Cheng G
        • Zhao C
        • Zhang L
        • Hong Y
        • Wan Q
        • He R
        • Wang Z
        Hs-CRP and all-cause, cardiovascular, and cancer mortality risk: a meta-analysis.
        Atherosclerosis. 2017; 259: 75-82
        • Lakoski SG
        • Cushman M
        • Criqui M
        • Rundek T
        • Blumenthal RS
        • D'Agostino Jr, RB
        • Herrington DM
        Gender and C-reactive protein: data from the Multiethnic Study of Atherosclerosis (MESA) cohort.
        Am Heart J. 2006; 152: 593-598
        • Meyer S
        • van der Meer P
        • van Deursen VM
        • Jaarsma T
        • van Veldhuisen DJ
        • van der Wal MH
        • Hillege HL
        • Voors AA
        Neurohormonal and clinical sex differences in heart failure.
        Eur Heart J. 2013; 34: 2538-2547
        • Grundy SM
        • Stone NJ
        • Bailey AL
        • Beam C
        • Birtcher KK
        • Blumenthal RS
        • Braun LT
        • de Ferranti S
        • Faiella-Tommasino J
        • Forman DE
        • Goldberg R
        • Heidenreich PA
        • Hlatky MA
        • Jones DW
        • Lloyd-Jones D
        • Lopez-Pajares N
        • Ndumele CE
        • Orringer CE
        • Peralta CA
        • Saseen JJ
        • Smith Jr, SC
        • Sperling L
        • Virani SS
        • Yeboah J
        2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2019; 73: 3168-3209
        • Peri-Okonny PA
        • Liu Y
        • Malaisrie SC
        • Huded CP
        • Kapadia S
        • Thourani VH
        • Kodali SK
        • Webb J
        • McAndrew TC
        • Leon MB
        • Cohen DJ
        • Arnold SV
        Association of statin use and mortality after transcatheter aortic valve replacement.
        J Am Heart Assoc. 2019; 8e011529
        • Asher J
        • Houston M
        Statins and C-reactive protein levels.
        J Clin Hypertens (Greenwich). 2007; 9: 622-628
        • Barter PJ
        • Brandrup-Wognsen G
        • Palmer MK
        • Nicholls SJ
        Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER Database.
        J Lipid Res. 2010; 51: 1546-1553
        • Ferrucci L
        • Fabbri E
        Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty.
        Nat Rev Cardiol. 2018; 15: 505-522
        • Qamar A
        • Giugliano RP
        • Bohula EA
        • Park JG
        • Jarolim P
        • Murphy SA
        • Blazing MA
        • Califf RM
        • Cannon CP
        • Braunwald E
        • Morrow DA
        Biomarkers and clinical cardiovascular outcomes with ezetimibe in the IMPROVE-IT trial.
        J Am Coll Cardiol. 2019; 74: 1057-1068
        • Ridker PM
        • Everett BM
        • Thuren T
        • MacFadyen JG
        • Chang WH
        • Ballantyne C
        • Fonseca F
        • Nicolau J
        • Koenig W
        • Anker SD
        • Kastelein JJP
        • Cornel JH
        • Pais P
        • Pella D
        • Genest J
        • Cifkova R
        • Lorenzatti A
        • Forster T
        • Kobalava Z
        • Vida-Simiti L
        • Flather M
        • Shimokawa H
        • Ogawa H
        • Dellborg M
        • Rossi PRF
        • Troquay RPT
        • Libby P
        • Glynn RJ
        • CANTOS Trial Group
        Antiinflammatory therapy with canakinumab for atherosclerotic disease.
        N Engl J Med. 2017; 377: 1119-1131