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. 2024 May 14:52:101423.
doi: 10.1016/j.ijcha.2024.101423. eCollection 2024 Jun.

N-terminal pro-B-type natriuretic peptide levels pre-transcatheter aortic valve implantation and relationship with long-term outcomes

Louise Marqvard Sørensen  1 , Jeppe Kofoed Petersen  1 , Jarl Emanuel Strange  1 , Lauge Østergaard  1 , Jacob Eifer Møller  1   2 , Morten Schou  3 , Lars Køber  1 , Ole de Backer  1 , Emil Fosbøl  1
Affiliations

N-terminal pro-B-type natriuretic peptide levels pre-transcatheter aortic valve implantation and relationship with long-term outcomes

Louise Marqvard Sørensen et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Blood levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been suggested as a future guidance tool for the selection of patients for aortic valve replacement. This study aimed to examine how levels of NT-proBNP pre-transcatheter aortic valve implantation (TAVI) is associated with one-year rates of heart failure (HF) admission and mortality following TAVI.

Methods: With Danish nationwide registries, we identified all patients undergoing TAVI from 2014 to 2021 who had at least one recorded NT-pro-BNP measurement within one year before TAVI. Patients were compared by quartiles of pre-TAVI NT-proBNP: quartile 4 (high NT-proBNP group) vs quartile 1-3 (low NT-proBNP group). Comparisons of all-cause mortality and HF-admissions were conducted using Kaplan-Meier analysis, cumulative incidence, and Cox analysis, as appropriate.

Results: We identified 1,140 patients undergoing first-time TAVI with a recorded NT-pro-BNP; 846 (74.2 %) with a low NT-proBNP (<420 pmol/L) (55.0 % male, median age 81 year) and 294 (25.8 %) with a high NT-proBNP (≥420 pmol/L) (53.1 % male, median age 82 year). A high versus low NT-proBNP was associated with increased one-year cumulative incidence of HF-admissions (9.1 % vs. 23.1 %, adjusted HR 2.00 [95 % CI, 1.40-2.85]) and all-cause mortality (6.0 % vs. 14.6 %, adjusted HR 1.95 [95 % CI: 1.24-3.07]). A high NT-proBNP was associated with higher rates of outcomes irrespective of previously known atrial fibrillation, HF, chronic kidney disease, and hypertension.

Conclusion: In patients undergoing TAVI, a baseline NT-proBNP ≥ 420 pmol/L was associated with increased one-year rates of HF-admission and mortality post-TAVI and may be utilized to identify a high-risk population.

Keywords: Aortic Stenosis; Aortic Valve Replacement; Implantation; N-Terminal Pro-B-Type Natriuretic Peptide; NT-proBNP; TAVI; Transcatheter Aortic Valve.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Inclusion of patients. This flowchart shows the inclusion of patients in the study.
Fig. 2
Fig. 2
One-year cumulative incidence of HF admission in patients undergoing TAVI. This figure shows the one-year cumulative incidence of HF admission post discharge in patients undergoing a first-time TAVI-procedure.
Fig. 3
Fig. 3
One-year cumulative incidence of all-cause mortality in patients undergoing TAVI. This figure shows the one-year cumulative incidence of all-cause mortality in patients undergoing a first-time TAVI procedure.
Fig. 4
Fig. 4
Forrest plot of one-year HF admissions rates and one-year mortality rates according to pre-specified subgroups. This figure shows the adjusted hazard ratios associated with high versus low NT-proBNP (≥420 pmol/L versus < 420 pmol/L) and one-year HF admission and all-cause mortality in patients with and without the following comorbidities: atrial fibrillation, HF, chronic kidney disease, and hypertension. For the adjusted hazard ratios, the group with NT-proBNP < 420 pmol/L served as a reference.
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