Preprocedural but not periprocedural high‐sensitive Troponin T levels predict outcome in patients undergoing transcatheter aortic valve implantation

Abstract

Elevated preprocedural hsTNT represents an independent risk predictor of all-cause death while periprocedural hsTNT elevation failed to show prognostic relevance.

Is elevation of N-terminal pro-B-type natriuretic peptide at discharge associated with 2-year composite endpoint of all-cause mortality and heart failure hospitalisation after transcatheter aortic valve implantation? Insights from a multicentre prospective OCEAN-TAVI registry in Japan

“…12 In contrast, Köhler et al suggested that preprocedural NT-proBNP was in fact not associated with all-cause mortality at a median of 290 days, in a multivariable analysis based on data from 259 patients in a single-centre prospective study. 10 Considering the short half-life of NT-proBNP (approximately 120 min) and the association between high baseline NT-proBNP and high short-term mortality risk, we believe that NT-proBNP level at discharge would be more beneficial than preprocedural NT-proBNP level for risk stratification of long-term prognosis after TAVI because the Open access TAVI procedure immediately improves left ventricular pressure overload. 13 16 However, we also must keep in mind that direct comparison of preprocedural and postprocedural NT-proBNP values is needed to reach a conclusion of this issue, as it is controversial with B-type natriuretic peptide (BNP).…”

“…1 2 7-9 However, previous studies described the relationship between NT-proBNP levels before the TAVI procedure and patient prognosis, and many of these data were derived from single-centre studies that only focused on all-cause mortality, without describing the incidence of HF. [10][11][12][13][14][15] For example, Ribeiro et al reported that a high baseline NT-proBNP was associated with a higher all-cause and cardiovascular mortality, as well as higher incidence of rehospitalisation for HF, in a single-centre study that included 333 patients, where differences in event rates might arise in the very early period after TAVI. 12 In contrast, Köhler et al suggested that preprocedural NT-proBNP was in fact not associated with all-cause mortality at a median of 290 days, in a multivariable analysis based on data from 259 patients in a single-centre prospective study.…”

“…For example, all reports were derived from a single centre with relatively small numbers of patients, and most studies evaluated NT-proBNP prior to performance of the TAVI procedure. [10][11][12][13][14][15] Since TAVI could dramatically release the left ventricle from pressure overload and contribute to the decrease in NT-proBNP level, we speculated that it is preferable to use NT-proBNP levels at discharge for risk stratification of long-term prognosis in patients who underwent TAVI. 13 16 Finally, the risk of hospitalisation for HF following TAVI was not investigated in most NT-proBNP studies.…”

“…13 16 Finally, the risk of hospitalisation for HF following TAVI was not investigated in most NT-proBNP studies. [10][11][12][13][14][15] Consequently, a multicentre TAVI study of the long-term prognostic impact of NT-proBNP levels at discharge warrants consideration. In the present study, we investigated NT-proBNP levels at discharge in terms of their impact on the 2-year composite endpoint of all-cause mortality and hospitalisation for HF, and usefulness for risk stratification in patients with AS who underwent TAVI.…”

Biomarkers in Aortic Stenosis: A Systematic Review

“…This appears to hold true regardless of whether the patients are treated conservatively or undergo TAVR or SAVR. [64][65][66] As was the case with BNP, the independent association between baseline troponin levels and worse prognosis after AVR implies that elevated troponins in AS are reflective of irreversible remodeling processes and that intervention before the onset of adverse remodeling, or early in its course, may improve prognosis after AVR.…”