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Published on: January 28, 2020
Correlation between staging classification of aortic stenosis based on the extent of cardiac damage and platelet
Tomer Maller1, Sharon Bruoha2, Ranel Loutati1
1Jesselson Integrated Heart Center, Shaare Zedek Medical Center Jerusalem and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
Platelet indices, including mean platelet volume (MPV), correlate with cardiac damage severity in patients after transcatheter aortic valve implantation (TAVI). Higher MPV is linked to more advanced aortic stenosis stages, suggesting its role in disease progression.
Area of Science:
- Cardiology
- Hematology
- Biomarkers
Background:
- Platelets are crucial in aortic stenosis (AS) and after transcatheter aortic valve implantation (TAVI).
- An echo-based staging system classifies severe AS patients by cardiac damage phenotype.
- This study investigates the relationship between AS stages and platelet indices post-TAVI.
Purpose of the Study:
- To correlate an echo-based staging system for aortic stenosis (AS) with platelet indices in patients following transcatheter aortic valve implantation (TAVI).
- To identify platelet-related biomarkers associated with cardiac damage severity in post-TAVI patients.
Main Methods:
- Prospective identification of severe AS patients undergoing TAVI, admitted to the intensive cardiac care unit (ICCU).
- Patients were stratified into 5 stages (0-4) based on extra-valvular cardiac damage.
- Baseline characteristics and complete blood counts, including mean platelet volume (MPV) and immature platelet fraction (IPF), were analyzed.
Main Results:
- Higher mean MPV values correlated with increased AS staging (P=0.02).
- Lower hemoglobin levels were also associated with higher AS stages (P=0.04).
- Multivariate analysis identified MPV (OR=2.6) and BMI (OR=1.17) as independently correlated with higher AS stages (0-3).
Conclusions:
- Mean platelet volume (MPV) and immature platelet fraction (IPF) showed a trend of increase in stages 0-3, with a decrease in stage 4, possibly due to bone marrow dysfunction.
- Higher MPV and lower hemoglobin levels were independently associated with more severe stages (0-3) of aortic stenosis post-TAVI.
Background:
Platelets play a key role in the natural history of aortic stenosis (AS) and after transcatheter aortic valve implantation (TAVI). An echo-based staging system stratifies patients with severe AS into 5 groups according to the associated cardiac damage phenotype. We aimed to correlate these AS stages with platelet indices in post-TAVI patients.
Methods:
Patients with severe AS who underwent TAVI and were admitted to intensive cardiac care unit (ICCU) were prospectively identified and divided into 5 groups according to extra-valvular cardiac damage [no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4)]. Baseline characteristics and complete blood count including mean platelet volume (MPV) and immature platelet fraction (IPF) were collected within 2 h after the procedure and analyzed in relation to aortic stenosis staging.
Results:
A total of 220 patients were included. The mean age was 81 years old and 112 (50.9%) were female. Two (1%) patients were classified in stage 0; 34 (15%) in stage 1; 48 (22%) in stage 2; 49 (22%) in stage 3 and 87 (40%) in stage 4. Higher mean MPV values were correlated with higher AS staging (10.8 fL, 11 fL, 11.3 fL and 10.8 fL in stages 1, 2, 3 and 4, respectively, P = 0.02) as well as lower hemoglobin values (12 mg/dl, 11.6 mg/dl, 11 mg/dl and 11.3 mg/dl in stages 1, 2, 3 and 4, respectively P = 0.04). Mean IPF values were 5.3%, 5.58%, 5.57% and 4.83% in stage 1, 2, 3 and 4, respectively (P = 0.4). In a multivariate logistic regression model only MPV (OR = 2.6, P = 0.03) and body mass index (BMI) (OR = 1.17, P = 0.004) were correlated with higher staging (0-3) of AS.
Conclusions:
Although IPF and MPV levels increased in stages 0-3, there was a decrease in indices in stage 4, (probably due to bone marrow dysfunction) in this end-stage population. Higher levels of MPV and lower levels of hemoglobin were independently correlated with higher stages (0-3) of AS.
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