Statin treatment long-term prognostic impact and its association with immune-inflammatory biomarkers levels in acute heart failure with preserved ejection fraction
K Stepien, P Rostoff, A Karcinska, J Czajkowska, A Pioskowik, A Manikowska, M Zuwala, A Siniarski, J Zalewski, J Nessler, G GajosAbstract
Background
Heart failure with preserved ejection fraction (HFpEF) is characterized by diastolic dysfunction of left ventricle. There is evidence on the role of inflammation in the pathophysiology of HFpEF, however this knowledge is yet to be utilized in clinical practice.
Purpose
We conducted a study to evaluate the association between statin therapy, levels of immune–inflammatory biomarkers (IIBs), and 5-year mortality among patients with HFpEF in a Polish population.
Methods
We analyzed 311 HFpEF patients hospitalized for acute heart failure between 2009 and 2019 included in the Lesser Poland Cracovian Heart Failure Registry. Baseline clinical, echocardiographic, and laboratory data, including IIBs, were collected. Patients were stratified according to statin therapy at discharge, and all-cause mortality was assessed.
Results
Elevated systemic immune-inflammation index (SII) without statins was associated with the lowest survival, whereas high lymphocyte-to-monocyte ratio (LMR) and low pan-immune-inflammation value (PIV) among statin users conferred the best outcomes. LMR was associated with reduced mortality in HFpEF patients not receiving statins (OR 0.46, 95% CI 0.26–0.82). NLR (neutrophil to lymphocyte ratio) (OR 1.51, 95% CI 1.03–2.22, P=0.034), dNLR (derived NLR) (OR 1.92, 95% CI 1.07–3.45, P=0.029), SII (OR 2.09, 95% CI 1.19–3.67, P=0.010) and PIV (OR 2.32, 95% CI 1.13–4.78, P=0.023) independently predicted mortality in the non-statin group, with statins attenuating the prognostic value of dNLR (P for interaction = 0.042) and PIV (P for interaction = 0.036).
Conclusions
The IIBs, particularly dNLR and PIV, were strong predictors of mortality in statin-naïve HFpEF patients, whereas statin therapy attenuated their prognostic value.SII level and statin usePIV level and statin use