Related Experiment Video
Updated: Jun 24, 2026
Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Neutrophil-to-lymphocyte ratio in patients with low-flow aortic stenosis undergoing transcatheter aortic valve
Carlo Mannina1, Esha Vaish2, Eric Kim2
1The Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Department of Internal Medicine, University of Palermo, Palermo, Italy.
Background:
The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and is associated with adverse cardiovascular outcomes. Low-flow (LF) aortic stenosis (AS) is a high-risk phenotype marked by advanced remodeling, frailty, and poor prognosis. We investigated whether NLR can improve risk stratification in patients with severe LF-AS evaluated for transcatheter aortic valve implantation (TAVI).
Methods:
A total of 925 consecutive patients with severe LF-AS referred for TAVI were evaluated. Primary endpoint was all-cause mortality.
Results:
Mean age was 79.8 ± 9.3 years; 291 (39.0%) patients were female; 745 (80.5%) underwent TAVI. During a mean follow-up of 25.6 months, death occurred in 187 (20.2%). In spline modeling, excess mortality appeared at NLR ≥4.5 and rose thereafter. In multivariable analysis, the highest baseline quartile vs. all other quartiles of NLR was associated with increased risk of death at 5 years [39% vs. 24%; adjusted hazard ratio (HR) 1.80; 95% confidence interval (CI), 1.22-2.65; p = 0.003], even after adjustments for pertinent covariates. Patients in the upper NLR quartile who underwent TAVI experienced over a 3-fold increased risk of death (HR 3.18, 95% CI: 1.93-5.24, p < 0.001). The survival benefit associated with TAVI was attenuated by 57% (interaction term p = 0.002, p for improved survival = 0.42). Higher NLR was associated with more frequent paravalvular leak (13.2% vs. 7.5%, p = 0.05).
Conclusion:
In patients with severe LF-AS, baseline high NLR was independently associated with almost doubling of the 5-year mortality risk. Patients in the upper NLR quartile who underwent TAVI showed lower survival benefit and more frequent paravalvular leak, suggesting that systemic inflammation may influence procedural outcomes and long-term prognosis.
