Biomarkers of Inflammation and Association with Cardiovascular Magnetic Resonance Imaging for Risk Stratification and Outcome in Patients with Severe Aortic Stenosis

<b>Background</b>: Inflammatory indices have been proposed as simple and routinely obtainable markers of systemic inflammation in cardiac disease. This study investigated whether the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the pan-immune inflammation value (PIV) serve as biomarkers for risk stratification and outcomes measures in patients with severe aortic stenosis (AS) following valve replacement (AVR). <b>Methods</b>: In this retrospective analysis (January 2017-June 2022), patients with AS underwent pre-procedural cardiovascular magnetic resonance (CMR) imaging and were assigned a treatment strategy by a multidisciplinary Heart Team: (1) transcatheter AVR, (2) surgical AVR, or (3) no valvular intervention. Kaplan-Meier estimates and regression analyses were used to demonstrate associations between the NLR, MLR, and PIV with myocardial fibrosis-assessed by late gadolinium enhancement (LGE) and extracellular volume (ECV) on CMR-and a combined endpoint of heart failure hospitalizations and all-cause mortality. <b>Results</b>: A total of 356 patients (median age: 80 years, 50% male) were followed for a median of 40 months, during which 162 (46%) reached the combined endpoint. Linear regression identified C-reactive protein, but not the presence of LGE or elevated ECV, as the only independent predictor of all three inflammatory indices (<i>p</i> for all <0.001). After multivariable adjustment for clinical (EuroSCORE II), laboratory (baseline N-terminal prohormone of brain natriuretic peptide [NT-proBNP] and C-reactive protein), and imaging parameters (AV mean pressure gradient, right ventricular ejection fraction, and ECV), the above-the-upper-quartile NLR (adjusted hazard ratio [aHR]: 1.45, 95%-confidence interval [CI]: 1.01-1.92, <i>p</i> = 0.042), MLR (aHR: 1.48, 95%-CI: 1.05-2.09, <i>p</i> = 0.025), and PIV (aHR: 1.56, 95%-CI: 1.11-2.21, <i>p</i> = 0.011) remained significantly associated with adverse outcomes. Following AVR, the median NLR (3.5 to 3.4) and PIV (460 to 376) showed a significant post-procedural decline compared to baseline (<i>p</i> ≤ 0.019 for both). <b>Conclusions</b>: Inflammatory indices are readily available biomarkers independently associated with adverse outcomes in severe AS following AVR. However, no significant relationship was observed between the NLR, MLR, PIV, and myocardial fibrosis on CMR.