Left atrial volume index predicts future improvement of B-type natriuretic peptide levels after transcatheter aortic valve replacement.

Minoru Yoshiyama,Yusuke Kure,Yosuke Takahashi,Asahiro Ito,Andrew T. Kim,Shinichi Iwata,Yasuhiro Izumiya,Tomohiro Yamaguchi,Mana Ogawa,Toshihiko Shibata,Ryosuke Yahiro,Tsukasa Okai

doi:10.1007/s10554-022-02538-7

Abstract

In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Furthermore, poor B-type natriuretic peptide (BNP) improvement is associated with increased morbidity and mortality. However, little is known about the clinical parameters related to the change in BNP levels after TAVR procedure. This study population consisted of 127 consecutive patients of symptomatic severe AS with preserved ejection fraction (EF) who underwent transfemoral TAVR (TF-TAVR). Comprehensive transthoracic echocardiography was performed prior to the day of TF-TAVR. BNP was measured serially before and 1year after TF-TAVR. The median BNP level was significantly decreased from 252.5pg/ml to 146.8pg/ml in all 127 patients 1year after TF-TAVR (P < 0.01). However, the patients could be divided into 2 groups according to decrease (72%) or increase (28%) in plasma BNP level. Multivariate logistic regression analysis revealed that Aortic valve (AV) peak velocity, pre-procedural BNP, and larger left atrial volume index (LAVI) were found to be an independent predictor of increased BNP level 1year after TAVR (OR 0.55, 95% CI 0.38-0.77; P < 0.01). LAVI were negatively correlated with the change in BNP level before and 1year after TAVR (r = 0.47, P < 0.01). The ROC analysis demonstrated that 52.9ml/m2 was the optimal cut-off value of LAVI for decreasing BNP 1year after TAVR (area under the curve 0.69) with 64% sensitivity and 70% specificity. In addition to AV peak velocity and pre-procedural BNP, LAVI independently predicts future improvement of BNP levels 1year after TAVR. Our findings indicate an additive predictive value of assessment of LAVI before TAVR procedure for risk stratification.

Highlights

Transcatheter aortic valve replacement (TAVR) is becoming an alternative intervention to surgical aortic valve replacement (SAVR) for high-risk, and even low-risk, patients with severe symptomatic aortic stenosis (AS) [1,2,3]
Our findings indicate an additive predictive value of assessment of left atrial volume index (LAVI) before transcatheter aortic valve replacement (TAVR) procedure for risk stratification
The median B-type natriuretic peptide (BNP) level in the total population of 127 patients significantly decreased from 252.5 pg/ml to 146.8 pg/ml 1 year after transfemoral TAVR (TF-TAVR) (p

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) is becoming an alternative intervention to surgical aortic valve replacement (SAVR) for high-risk, and even low-risk, patients with severe symptomatic aortic stenosis (AS) [1,2,3]. It is clinically important to identify patients at high risk for heart failure after TAVR. Patients with poor improvement in BNP levels after TAVR have less symptomatic improvement and higher long-term mortality rates than patients with lower BNP levels [10,11,12]. Around 35–40% of patients show persistent elevated plasma BNP levels at their 1-year followup after TAVR, and these patients have higher rates of morbidity and mortality [10, 11]. It is important to remeasure BNP levels at 1-year follow-up appointments to predict prognosis in AS patients who have undergone TAVR. In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Little is known about the clinical parameters related to the change in BNP levels after TAVR procedure

Methods

Results

Conclusion