Abstract 19213: Long-Term Prognostic Value of and Serial Changes in Plasma N-terminal Pro B-type Natriuretic Peptide in Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

Background: Little is known about the usefulness of evaluating cardiac neurohormones in patients undergoing transcatheter aortic valve implantation (TAVI). The objectives of this study were to evaluate the baseline values and serial changes of NT-proBNP following TAVI, its related factors and prognostic value. Methods and Results: A total of 333 consecutive patients undergoing TAVI were included. Baseline, procedural and follow-up (median: 20 [8 to 35] months) data were prospectively collected. Systematic NT-proBNP measurements were performed at baseline, hospital discharge, 1-month, 6- to12 months, and yearly thereafter. Baseline NT-proBNP values were elevated in 86% of the patients (median: 1692 [667-3910] pg/mL); lower left ventricular ejection fraction and stroke volume index, higher LV mass, and renal dysfunction were associated with greater baseline values (p<0.01 for all). Higher NT-proBNP levels were independently associated with increased long-term overall and cardiovascular mortality (P<0.001 for both), with a baseline cut-off level of ~2,000 pg/mL best determining poorer outcomes (P<0.001). At 6- to 12-month follow-up, NT-proBNP levels had decreased (P<0.001) by 23 (IQR: -62 to +32)% and remained stable up to 4-year follow-up. In 39% of the patients, however, NT-proBNP values increased to some degree. Pre-procedural chronic atrial fibrillation, lower mean transaortic gradient and moderate/severe mitral regurgitation were the predictors of the lack of NT-proBNP improvement after TAVI (P<0.01 for all). Conclusions: Very high NT-proBNP levels were observed in most TAVI candidates, which in turn predicted a higher overall and cardiac mortality after a median follow-up of approximately 2 years. TAVI was associated with a significant decrease in NT-proBNP levels over time, but a lack of improvement was observed in more than one third of the patients, mainly due to the presence of chronic atrial fibrillation, a lower transvalvular gradient and moderate-to-severe mitral regurgitation. These results strongly suggest the usefulness of implementing NT-proBNP measurements for the clinical decision-making process and follow-up of TAVI patients.