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The Inflammatory Burden Index as a Simple and Accessible Tool to Predict Clinical Outcomes After TAVR
Session:
Sessão de Posters 26 - Implantação transcateter da válvula aórtica (TAVI): desfechos, complicações e biomarcadores
Speaker:
Rafael Viana
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Rafael Viana; Marta Figueiredo; Raquel Silva; Rita Rocha; Rita Louro; Antonio Almeida; Gustavo Mendes; Diogo Brás; David Neves; Angela Bento; Renato Fernandes; Lino Patricio
Abstract
<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Background: Inflammation is increasingly recognized as a central contributor to the pathogenesis and prognosis of cardiovascular disease. Recent evidence suggests that inflammatory status significantly affects both procedural success and long-term outcomes following transcatheter aortic valve replacement (TAVR). The inflammatory burden index (IBI), a composite marker of systemic inflammation and immune balance, has not yet been evaluated in the TAVR setting.</span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Purpose: To assess the impact of pre-procedural inflammatory status, measured by the IBI, on clinical outcomes after TAVR.</span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Methods: Consecutive patients undergoing TAVR at our center between July 2020 and October 2024 were included. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization. IBI was calculated as high-sensitivity C-reactive protein (hs-CRP) × neutrophils / lymphocytes. Receiver operating characteristic (ROC) curve analysis with the Youden index was used to determine the optimal IBI cut-off for predicting the primary endpoint.</span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Results: A total of 400 patients were included (53% male; mean age 82 ± 5 years). 75 patients reached the primary endpoint during a mean follow-up of 347 ± 45 days (range 184–365 days). Patients meeting the primary endpoint more frequently had bicuspid aortic valve (35% vs 17%, p=0.027), post-TAVR stroke (56% vs 18%, p=0.004) and bleeding events (36% vs 17%, p=0.013). Regarding laboratory values, patients who died or were hospitalized had higher creatinine (1.3 vs 1.0 mg/dL, p=0.032), NT-proBNP (3720 vs 1690 pg/mL, p=0.035) and IBI (4.7 vs 2.0, p=0.006). No other significant demographic, echocardiographic, or clinical differences were observed.</span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">In a binary logistic regression including all significant variables, IBI emerged as an independent predictor of the primary endpoint (p=0.041). ROC analysis showed moderate discriminatory power (AUC = 0.624) with an optimal cut-off of 3,1 (sensitivity 61%, specificity 59%). Besides IBI, bicuspid aortic valve (p=0.012) and stroke (p=0.014) were independent predictors of death or heart failure hospitalization.</span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Conclusion: Higher pre-procedural inflammatory burden, as measured by the IBI, is independently associated with increased risk of all-cause mortality or heart failure hospitalization after TAVR. An IBI cut-off of 4.3 demonstrated moderate predictive ability. These findings suggest that systemic inflammation contributes meaningfully to post-TAVR prognosis and that IBI may serve as a simple, accessible tool for risk stratification. Additionally, bicuspid aortic valve anatomy and post-procedural stroke also emerged as important independent predictors of adverse outcomes.</span></span></p>
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