Identificazione dei predittori di outcome non cardiaci nei pazienti candidati a TAVI

Introduction Systemic inflammation, endothelial dysfunction and non-cardiac comorbidities interplay represent a state of increased vulnerability in patients with degenerative calcific aortic stenosis. This condition is involved in treatment outcomes and its specific and deep characterization could improve TAVR candidate selection and outcomes. Objectives It is proposed an Observational Prospective Study aimed at the identification of a definite set of non-cardiac 1-year outcome predictors to develop a risk assessment tool for TAVR candidates. Material and Methods 66 patients underwent TAVI in Gemelli Molise Hospital and were enrolled in the study. Non-cardiac outcome predictors will be identified starting from four domains: general variables, biochemical variables, comorbidities (including frailty), inflammation and endothelial dysfunction markers. Results Of 66 patients, 59 completed the follow up. In patients with MACE, the mental domain of frailty was more compromised (1.46±0.87 vs 0.83±0.89, p 0.033), in particular in depression item (0.75±0.45 vs 0.38±0.49, p 0.028). Furthermore, patients who experienced MACE had higher value of neutrophil count, neutrophil to lymphocyte ratio at admission and discharge, and fibrinogen. Among the comorbidities, arterial hypertension was more frequent in MACE group. Interestingly, the mental domain correlated with social support scale, physical domain and handgrip. The incidence of MACE was 27% while mortality 10.3%, with more deaths in patients with higher degree of frailty. The multivariate analysis showed that mental domain predicted MACE (OR 5.36; CI 1.35-21.2; p 0.017). Survival curves revealed a statistically significant difference between patients with or without depression (Log-rank 0.029). The Cox regression confirmed the mental domain as powerful predictor of MACE (adjusted multivariate hazard ratio 2.016, 95% CI 1.101-3.690, p 0.023). Conclusions This study showed that frailty, in particular mental domain and depression, plays an important role in prognosis of patients undergoing TAVI.