NT-pro-BNP pre TAVI and relationship with long-term outcomes

Abstract

Abstract Background Blood levels of NT-proBNP correlates with aortic valve stenosis and has been suggested as a future target for intervention or selection of patients for aortic valve replacement. Purpose To examine how levels of NT-proBNP pre-TAVI relates to risk of one-year rates of heart failure admission and mortality in patients undergoing TAVI. Methods With Danish nationwide registries, we identified all patients undergoing TAVI from 2014–2021 who had available pre-TAVI NT-pro-BNP measured up to one year prior to TAVI. According to NT-proBNP blood samples, patients were classified according to quartiles of pre-TAVI NT-proBNP levels. The quartiles were then converted into two final groups: Q1-3 including patients with NT-proBNP< 420 pmol/L and Q4 including patients with a NT-proBNP ≥ 420 pmol/L. Groups were compared using cumulative incidence curves of post-TAVI heart failure admissions and Kaplan-Meier estimates to assess comparative all-cause mortality. Adjusted rates of outcomes were assessed, using multivariable Cox analysis, with patients with NT-proBNP< 420 pmol/L serving as reference. Results We identified 1,140 patients undergoing a first-time TAVI procedure (53.1% male, median age 81 year) with an availabel NT-pro-BNP (19.5% of the national chohort of TAVI patients). Of these, 846 (74.21%) patients had a NT-proBNP < 420 pmol/L (55.0% male, median age 81 year) and 294 (25.79%) patients with NT-proBNP ≥ 420 pmol/L (53.1% male, median age 82 year). The one-year cumulative incidence of heart failure was 9.1% and 23.1% for patients with a NT-proBNP <420 pmol/L and ≥ 420 pmol/L, respectively (p<0.001) (Figure 1). This corresponded to an adjusted hazard ratio of 1.91 (95% CI: 1.33–2.74). The one-year cumulative incidence of all-cause mortality was 6.0% and 14.6% for patients with a NT-proBNP <420 pmol/L and ≥ 420 pmol/L, respectively (p<0.001) (Figure 1). This corresponded to an adjusted hazard ratio of 1.85 (95% CI: 1.17-2.92). Conclusion In patients undergoing TAVI, a baseline NT-proBNP ≥ 420 pmol/L was associated with increased one-year rates of heart failure admissions and mortality post-TAVI. The results suggest that NT-proBNP is associated with adverse outcomes on the long-term and that this could be a target for intervention.Figure 1:HF admission and mortality