title: Impact of clinical and procedural factors upon C reactive protein dynamics following transcatheter aortic valve implantation.
abstract: OBJECTIVE
  To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure (or up to discharge). Procedural factors and 30-d safety outcomes according to the Valve Academic Research Consortium 2 definition were collected.
  
  
  RESULTS
  Following TAVI, CRP significantly increased reaching a peak on day 3 of 87.6 ± 5.5 mg/dL, P < 0.001. Patients who developed clinical signs and symptoms of sepsis had significantly increased levels of CRP (P < 0.001). The presence of diabetes mellitus was associated with a significantly higher peak CRP level at day 3 (78.4 ± 3.2 vs 92.2 ± 4.4, P < 0.001). There was no difference in peak CRP release following balloon-expandable or self-expandable TAVI implantation (94.8 ± 9.1 vs 81.9 ± 6.9, P = 0.34) or if post-dilatation was required (86.9 ± 6.3 vs 96.6 ± 5.3, P = 0.42), however, when pre-TAVI balloon aortic valvuloplasty was performed this resulted in a significant increase in the peak CRP (110.1 ± 8.9 vs 51.6 ± 3.7, P < 0.001). The development of a major vascular complication did result in a significantly increased maximal CRP release (153.7 ± 11.9 vs 83.3 ± 7.4, P = 0.02) and there was a trend toward a higher peak CRP following major/life-threatening bleeding (113.2 ± 9.3 vs 82.7 ± 7.5, P = 0.12) although this did not reach statistical significance. CRP was not found to be a predictor of 30-d mortality on univariate analysis.
  
  
  CONCLUSIONS
  Careful attention should be paid to baseline clinical characteristics and procedural factors when interpreting CRP following TAVI to determine their future management.
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Ruparelia
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Vasileios F
authors.initials: VF
authors.lastname: Panoulas
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Frame
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Ben
authors.initials: B
authors.lastname: Ariff
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Sutaria
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Fertleman
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cousins
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Jon
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Colin
authors.initials: C
authors.lastname: Bicknell
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chukwuemeka
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Sayan
authors.initials: S
authors.lastname: Sen
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Iqbal S
authors.initials: IS
authors.lastname: Malik
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Ghada W Mikhail, Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London W12 0HS, United Kingdom.
authors.forename: Ghada W
authors.initials: GW
authors.lastname: Mikhail
keywords: Aortic stenosis; C reactive protein; Inflammation; Transcatheter aortic valve implantation