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Liebetrau C, Gaede L, Kim WK, Arsalan M, Blumenstein JM, Fischer-Rasokat U, Wolter JS, Kriechbaum S, Huber MT, van Linden A, Berkowitsch A, Dörr O, Nef H, Hamm CW, Walther T, Möllmann H. Early changes in N-terminal pro-B-type natriuretic peptide levels after transcatheter aortic valve replacement and its impact on long-term mortality. Int J Cardiol 2019; 265:40-46. [PMID: 29885699 DOI: 10.1016/j.ijcard.2018.02.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/03/2017] [Accepted: 02/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) levels correlate with higher peri-procedural mortality after transcatheter aortic valve replacement (TAVR). The long-term prognostic value of NT-proBNP within the first days after TAVR, however, remains unclear. This study examined early changes in NT-proBNP prior to and within 6 days after TAVR, the diagnostic value of this biomarker regarding aortic regurgitation (AR), and its prognostic value regarding one-year mortality. METHODS AND RESULTS NT-proBNP concentrations were measured in 504 consecutive patients undergoing transapical (TA) or transfemoral (TF) TAVR before and directly after TAVR as well as 4 h and 1, 2, 3, and 6 days after TAVR. The follow-up period was 1 year. NT-proBNP was elevated in all patients at baseline (median 2141 ng/L [IQR 1021-5319 ng/L]). NT-proBNP changes in the first 6 days after TAVR showed significant differences depending on the approach, with a greater and more prolonged rise evident in TA-TAVR patients. NT-proBNP was an independent predictor of mortality in TA patients with AR, with an AUC of 0.794 (95% CI 0.663-0.925; P = 0.003) when measured on day 3 after TAVR. For TF patients with AR and reduced left ventricular systolic function, the AUC for prediction of mortality was 0.897 (95% CI 0.778-1.0; P = 0.004) on day 2. CONCLUSIONS The prognostic information of early post-procedural NT-proBNP concentrations is superior to pre-procedural values regarding all-cause mortality within 1 year. Post-procedural NT-proBNP must be interpreted in relation to the TAVR approach. NT-proBNP predicts mortality in TF-TAVR patients with AR and reduced left ventricular function.
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Affiliation(s)
- C Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany.
| | - L Gaede
- St. Johannes Hospital, Dept. of Cardiology, Dortmund, Germany
| | - W K Kim
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - M Arsalan
- DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - J M Blumenstein
- St. Johannes Hospital, Dept. of Cardiology, Dortmund, Germany
| | - U Fischer-Rasokat
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - J S Wolter
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - S Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - M T Huber
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - A van Linden
- DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - A Berkowitsch
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - O Dörr
- Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - H Nef
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - C W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - T Walther
- DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - H Möllmann
- St. Johannes Hospital, Dept. of Cardiology, Dortmund, Germany
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