What new research tells us about TAVR and platelet-to-lymphocyte ratios
Patients with an elevated platelet-to-lymphocyte ratio (PLR) before transcatheter aortic valve replacement (TAVR) do not face a heightened risk of adverse cardiovascular outcomes, according to a new study published in the American Journal of Cardiology.
“The PLR represents a novel, blood-based biomarker that can capture and simplify complex physiological processes, such as inflammation, into practical values that can be used by clinicians in their daily practice,” wrote first author Rohan V. Navani, MD, a cardiologist at Alfred Hospital in Australia, and colleagues. “An elevated PLR has been associated with a poorer prognosis in patients with acute coronary syndrome.”
The authors tracked data from nearly 500 patients who underwent TAVR for severe symptomatic aortic stenosis. All patients were treated at the same facility in Australia from August 2008 to January 2019. While 54% of patients were men, the median age was 84 years old. Also, 73% of TAVR procedures included a self-expanding device; transfemoral access was used for 95% of the procedures.
Each patient’s PLR was calculated using the same blood sample originally obtained approximately one day before the procedure. Aortic stenosis severity was confirmed using transthoracic echocardiography.
Overall, an elevated PLR was not independently associated with major adverse cardiovascular outcomes among TAVR patients. Older patients were more likely to have a higher PLR. Patients with diabetes, meanwhile, were more likely to present with a lower PLR.
The team did note that preliminary studies exploring this topic had found a relationship between PLR ratios and TAVR outcomes. They emphasized, however, that their own analysis covered many more patients.
“Our study's external validity is strengthened by its statistical design; a large number of consecutive patients were analyzed with scarce missing data and we accounted for different PLR cutoffs with multiple statistical models,” the authors wrote. “Because our results strongly suggest that preprocedure PLR has no clinical utility in predicting adverse outcomes after TAVR, given the intraprocedural systemic inflammatory response that is generated by the TAVR procedure itself, we propose that future biomarker research should focus on postprocedure PLR as a potential convenient, inexpensive risk-stratification biomarker.”
Read the full analysis here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.