title: Pro B-type natriuretic peptide plasma value: a new criterion for the prediction of short- and long-term outcomes after transcatheter aortic valve implantation.
abstract: BACKGROUND
  To determine the prognostic value of pro B-type natriuretic peptide (pro-BNP) to predict mortality after transcatheter aortic valve implantation (TAVI). Logistic EuroSCORE (LES) overestimates observed mortality after TAVI. A new risk score specific to TAVI is needed to accurately assess mortality and outcome.
  
  
  METHODS
  Eighty-five patients were included. Indications for TAVI were nonoperable or surgically high-risk patients (LES>20%). Pro-BNP was measured 24h before the procedure. Cox proportional hazards model was used to evaluate clinical factors. The predictive accuracy of these Cox models was determined by using time-dependent receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  Pro-BNP levels (log-transformed) were significantly higher in non-survivors than in survivors at 30 days (3.36 ± 0.43 vs. 3.81 ± 0.43, p<0.004) and at the end of follow-up (3.34 ± 0.42 vs. 3.63 ± 0.48, p<0.011). Multivariate analysis revealed that only increased log pro-BNP levels were associated with higher mortality rate at short [hazard ratio (HR) (95% confidence intervals (CI)]=5.35 (1.74-16.5), p=0.003] and long-term follow-ups [HR=11 (CI: 1.51-81.3), p=0.018]. LES was not associated with increased mortality at either time point [HR=1.03 (CI: 0.95-1.10), p=0.483 and HR=1.03 (CI: 0.98-1.07), p=0.230, respectively]. At 30, 90, 180, and 365 days, the c-index was 0.72 for log pro-BNP and 0.63 for LES (p=0.044).
  
  
  CONCLUSIONS
  Pre-procedure log transform of plasma pro-BNP levels are an independent and strong predictor of short- and long-term outcomes after TAVI and are more discriminatory than LES.
authors.affiliation: Clinical University Hospital of Santiago de Compostela, Spain. Electronic address: birihh@yahoo.es.
authors.forename: Diego
authors.initials: D
authors.lastname: López-Otero
authors.forename: Ramiro
authors.initials: R
authors.lastname: Trillo-Nouche
authors.forename: Francisco
authors.initials: F
authors.lastname: Gude
authors.forename: Belen
authors.initials: B
authors.lastname: Cid-Álvarez
authors.forename: Raimundo
authors.initials: R
authors.lastname: Ocaranza-Sanchez
authors.forename: Melisa Santas
authors.initials: MS
authors.lastname: Alvarez
authors.forename: Pamela V
authors.initials: PV
authors.lastname: Lear
authors.forename: José R
authors.initials: JR
authors.lastname: Gonzalez-Juanatey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000639:trends*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: AS; Aortic stenosis; BNP; CABG; EuroSCORE; European System for Cardiac Operative Risk Evaluation; GFR; LES; Log pro-BNP; Logistic European System for Cardiac Operative Risk Evaluation; NYHA; New York Heart Association; Pro B-type natriuretic peptide; Pro-BNP; TAVI; Transcatheter aortic valve implantation; aortic stenosis; coronary artery bypass grafting; glomerular filtration rate; logarithm of pro B-type natriuretic peptide; pro B-type natriuretic peptide; transcatheter aortic valve implantation