Does NT-pro-B-Type Natriuretic Peptide predict the outcomes in patients undergoing transcatheter aortic valve implantation for severe aortic valve stenosis?

Elhmidi, Yacine; Bleiziffer, Sabine; Piazza, N; Ruge, Hendrik; Hutter, Andrea; Opitz, A; Kornek, Matthias; Mazzitelli, Domenico; Bauernschmitt, Robert; Lange, R

doi:10.1055/s-0030-1268944

Cited by 3 publications

(7 citation statements)

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“…The research results indicate that preoperative NT-pro-NBP levels of >4853 ng/L can independently predict adverse prognoses and in-hospital and 1-year mortality after TAVR. Older patients with severe AS had higher NT-pro-BNP values (median: 1936 ng/L, IQR: 553–4988), consistent with Elhmidi et al 13 This may be due to the patients’ advanced ages, increased left ventricular load, and impaired myocardial function, resulting in poor postoperative survival. 15 Our results revealed that older adults with preoperative NT-pro-BNP > 4853 ng/L who underwent TAVR typically had severe comorbidities: (1) lower hemoglobin and serum albumin levels; (2) impaired renal function, indicated by visibly higher BUN, Cr, and estimated glomerular filtration rate (eGFR) levels; (3) more chronic diseases, such as diabetes or need for hemodialysis; and (4) poorer left ventricular function.…”

Section: Discussionsupporting

confidence: 85%

“…19 NT-pro-BNP can predict the 30-day mortality of patients who undergo TAVR. 20,21 However, consistent with Elmidi et al, 13 our results also did not reveal a correlation between NT-pro-BNP values and 30-day mortality rates; this may be because the NT-pro-BNP value in this study for sorting patients into groups (NT-pro-BNP > 4853 ng/L) was relatively close to the NT-pro-BNP value in Elmidi et al (NT-pro-BNP ≥ 4691 ng/L). We did observe a correlation between NT-pro-BNP levels and 1-year mortality, consistent with Huang et al 8 ; in their study, patients with heart failure in the high NT-pro-BNP group had significantly more comorbidities and higher in-hospital and 1-year allcause mortality rates than those in the low NT-pro-BNP group.…”

Section: Discussionsupporting

confidence: 80%

“…8 This result is closely related to left ventricular systolic and diastolic dysfunction, arterial hypertension, and valve diseases; and hemodynamics in the ventricles affects long-term survival. 9,13 Even after adjustment for age, gender, hemoglobin, serum albumin, diabetes, dialysis, and LVEF < 45%, the betweengroup differences were still identified in postoperative ECMO installations, number of days in hospital, and 1-year mortality. Therefore, NT-pro-BNP can be expected to have prognostic value for older adults with severe AS who underwent TAVR.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The effects of preoperative NT-pro-BNP levels are analyzed based on published research. 13,14 According to determine the cutoff value by receiver operating characteristic curve analysis and Youden's index of their serum NT-pro-BNP levels, the patients were divided into two groups (NT-pro-BNP levels ≤4853 vs >4853).…”

Section: Study Design and Participantsmentioning

confidence: 99%

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Correlation of N-terminal-pro-Brain Natriuretic Peptide (NT-pro-BNP) with postoperative outcomes of older patients undergoing transcatheter aortic valve replacement

Huang

Chang

Chen

et al. 2023

Journal of the Chinese Medical Association

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Background: Patients undergoing transcatheter aortic valve replacement surgery (TAVR) are typically older adults with multiple chronic diseases and therefore have a high surgical risk. The N-terminal of brain natriuretic peptide (BNP) and pro-BNP, referred to as NT-pro-BNP, is an easily measurable biomarker of heart failure. Studies on correlation between higher NT-pro-BNP levels and adverse prognoses after TAVR have yielded inconsistent results. Here, we investigated whether preoperative NT-pro-BNP levels are correlated with outcomes among older adults undergoing TAVR. Methods: This retrospective study included older adults with severe aortic stenosis (AS) who received TAVR from a medical center between January 2013 and June 2017. The patients’ demographics, preoperative laboratory data, postoperative complications, and 1-year mortality were recorded. They were divided into two groups based on their preoperative NT-pro-BNP levels. The post-TAVR outcomes in the two groups were analyzed using a multivariate logistic regression analysis of the binary results. Results: Of the 132 patients included (mean age: 81.5 ± 8.1 years; 47% men), 96 (72.7%) had preoperative NT-pro-BNP levels ≤ 4853 ng/L, and 36 (27.3%) had preoperative NT-pro-BNP levels > 4853 ng/L. The postoperative outcomes were significantly better in the NT-pro-BNP≤4853 group than in the NT-pro-BNP>4853 group: postoperative extracorporeal membrane oxygenation fittings (4.2% vs 16.7%, p = 0.025), number of days in hospital (17.5 ± 21.0 vs 27 ± 17.0, p = 0.009), in-hospital mortality (4.2% vs 16.7%, p = 0.025), and 1-year mortality (11.5% vs 38.9%, p = 0.001); the significant differences persisted after controlling for other variables. Conclusion: For older patients undergoing TAVR with NT-pro-BNP levels > 4853 ng/L, their postoperative outcomes and 1-year mortality were correlated. Thus, NT-pro-BNP is useful for the risk assessment of patients undergoing TAVR and should be regarded as a biomarker in future risk assessments.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Design and Participantsmentioning

confidence: 99%

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Correlation of N-terminal-pro-Brain Natriuretic Peptide (NT-pro-BNP) with postoperative outcomes of older patients undergoing transcatheter aortic valve replacement

Huang

Chang

Chen

et al. 2023

Journal of the Chinese Medical Association

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B‐type natriuretic peptide is associated with remodeling and exercise capacity after transcatheter aortic valve replacement for aortic stenosis

Sato

Kumar

Krishnaswamy

et al. 2018

Clinical Cardiology

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Background We aimed to assess longitudinal changes of B‐type natriuretic peptide (BNP) in aortic stenosis (AS) patients treated by transcatheter aortic valve replacement (TAVR). Methods From our TAVR database, we identified 193 consecutive patients with severe symptomatic AS who underwent TAVR and were prospectively followed using serial BNP levels and echocardiography. Patients were divided into subgroups according to type of left ventricular (LV) remodeling as having normal LV mass and relative wall thickness, or showing concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Results At baseline, 30 patients (16%) had EH, 115 (60%) had CH, 37 (19%) had CR, and 11 (6%) had normal LV geometry. After TAVR, BNP decreased in the first 30 days, with further improvement during follow‐up. Patients with EH had higher BNP at baseline ( P < 0.01) and a greater subsequent decrease ( P < 0.001). During the median follow‐up of 1331 days (interquartile range: 632‐1678), 119 (62%) patients died. BNP showed a time‐dependent association with all‐cause mortality both in a univariable (hazards ratio [HR] 1.24, 95% confidence interval [CI]: 1.04‐1.47, P = 0.017), and in a multivariable model with Society of Thoracic Surgeons score and baseline BNP forced into the analysis (HR 1.32, 95% CI: 1.001‐1.73, P = 0.049). Elevated BNP was associated with a larger LV end‐diastolic volume index ( P < 0.001) and shorter 6‐minute walk test distance ( P = 0.013) throughout follow‐up. Conclusion In patients with AS, BNP was associated with LV remodeling phenotypes and functional status before and after TAVR. Elevated BNP levels were associated with poor prognosis.

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N-terminal pro-B-type natriuretic peptide is associated with clinical outcomes after transcatheter aortic valve replacement

Yu,

Wang

2023

J Cardiothorac Surg

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Background Limited data on the prognostic value of periprocedural changes of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) after transcatheter aortic valve replacement (TAVR). Methods Data of plasma NT-proBNP were retrospectively collected in 357 patients before TAVR procedure and at discharge from January 1, 2018 to December 31, 2021 in our single center. Patients were grouped as responders and non-responders according to the NT-proBNP ratio (postprocedural NT-proBNP at discharge/ preprocedural NT-proBNP). Responders were defined as NT-proBNP ratio < 1 and non-responders were defined as NT-proBNP ratio ≥ 1. Outcomes were defined according to the Valve Academy Research Consortium (VARC)-3 criteria. Results A total of 234 patients (65.5%) and 123 patients (34.5%) were grouped as the responders and the non-responders, respectively. Responders and non-responders were significantly different in both median preprocedural (2103.5 vs. 421.0 pg/ml, p < 0.001) and postprocedural (707.6 vs. 1009.0, p < 0.001) NT-proBNP levels. Patients in the non-responder group were more inclined to have comorbidities of hypertension (73.2% vs. 51.7%, p < 0.001), hyperlipidaemia (46.3% vs. 34.6%, p = 0.031), peripheral vascular disease (20.3% vs. 8.5%, p = 0.001) and pure aortic insufficiency (15.4% vs. 4.3%, p < 0.001). In the contrast, patients in the responder group had higher prevalence of maximum transvalvular velocity (4.6 vs. 4.2 m/s, p < 0.001), reduced left ventricular ejection fraction (58.0% vs. 63.0%, p < 0.001), heart failure (9.4% vs. 2.4%, p = 0.014), mitral regurgitation ≥ moderate (13.7% vs. 4.9%, p = 0.010), tricuspid regurgitation ≥ moderate (12.0% vs. 2.4%, p = 0.002), and pulmonary hypertension (32.9% vs. 13.0%, p < 0.001). Patients in the non-responder group were moderately longer than the responder group in total hospitalization length (14 vs. 12 days, p < 0.001). The non-responder group were significantly associated with cumulative all-cause mortality (p = 0.009) and cardiac mortality (p < 0.001) during the follow-up period. Conclusions Periprocedural changes of NT-proBNP is clinically useful for the risk stratification of survival in patients after TAVR.

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Does NT-pro-B-Type Natriuretic Peptide predict the outcomes in patients undergoing transcatheter aortic valve implantation for severe aortic valve stenosis?

Cited by 3 publications

References 0 publications

Correlation of N-terminal-pro-Brain Natriuretic Peptide (NT-pro-BNP) with postoperative outcomes of older patients undergoing transcatheter aortic valve replacement

Correlation of N-terminal-pro-Brain Natriuretic Peptide (NT-pro-BNP) with postoperative outcomes of older patients undergoing transcatheter aortic valve replacement

B‐type natriuretic peptide is associated with remodeling and exercise capacity after transcatheter aortic valve replacement for aortic stenosis

N-terminal pro-B-type natriuretic peptide is associated with clinical outcomes after transcatheter aortic valve replacement

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