Systemic Inflammatory Burden Is Independently Associated with Anemia After Transcatheter Aortic Valve Implantation in Patients Referred to Cardiac Rehabilitation.

Background

Anemia is frequently observed in patients undergoing transcatheter aortic valve implantation (TAVI) and may reflect persistent biological vulnerability in the post-procedural period. The relationship between systemic immune-inflammatory burden and anemia at entry into structured cardiac rehabilitation (CR) after TAVI remains insufficiently explored.

Methods

This retrospective observational study included 80 consecutive patients referred to CR after successful TAVI. Anemia was defined by World Health Organization (WHO) criteria (hemoglobin <13 g/dL in men; <12 g/dL in women). Systemic inflammatory burden was assessed using C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and the systemic immune-inflammation index (SII = platelet × neutrophil/lymphocyte). Multivariable logistic regression, adjusted for age, sex, body mass index (BMI), type 2 diabetes mellitus, and estimated glomerular filtration rate (eGFR), was used to evaluate independent associations with anemia.

Results

Anemia was present in 67.5% of patients at CR entry. Compared with non-anemic patients, anemic patients exhibited significantly higher CRP (4.25 vs. 2.58 mg/L; p = 0.014), NLR (2.86 vs. 2.34; p = 0.004), PLR (132.33 vs. 102.13; p = 0.003), and SII (566.01 vs. 448.30; p = 0.011). In multivariable models, NLR (OR 4.09; 95% CI 1.50-11.19; p = 0.006), PLR (OR 4.89; 95% CI 1.41-17.02; p = 0.013), SII (OR 4.96; 95% CI 1.35-18.14; p = 0.016), and CRP (OR 2.17; 95% CI 1.07-4.39; p = 0.032) were independently associated with anemia. Area under the ROC curve (AUC) was 0.70 for NLR and PLR, 0.68 for SII, and 0.67 for CRP.

Conclusions

Systemic inflammatory burden is independently associated with anemia at the time of entry into CR facility after TAVI. These findings support an integrated approach to patient evaluation and provide a basis for future mechanistic and interventional studies.