title: The evolution and prognostic value of N-terminal brain natriuretic peptide in predicting 1-year mortality in patients following transcatheter aortic valve implantation.
abstract: OBJECTIVE
  N-terminal pro-brain natriuretic peptide (NT-proBNP) has been found to correlate with the severity of aortic valve stenosis and to provide prognostic information in aortic stenosis patients undergoing surgical aortic valve replacement. There is a paucity of data describing the association between clinical outcomes after TAVI and NT-proBNP levels. We investigated the evolution and prognostic value of NT-proBNP levels after TAVI.
  
  
  RESULTS
  We prospectively collected data on the baseline characteristics, NT-proBNP levels (baseline, post-treatment and discharge) and adverse clinical outcomes of patients undergoing TAVI from 2007 to 2010. Using a univariable and multivariable Cox regression model, pre- and postimplantation NT-proBNP tertile levels were correlated to 30-day and 1-year mortality. A total of 373 patients underwent TAVI with either the Medtronic CoreValve or Edwards SAPIEN prosthesis. The cumulative 30-day and 1-year mortality was 7.3% and 18%, respectively. Rehospitalization for heart failure was observed in 0.8% at 30 days and 7.8% at 1 year. The tertile baseline NT-proBNP levels were identified as ≤1570 ng/L, 1571 to 4690 ng/L and ≥4691 ng/L. In the univariable analysis, baseline (HR, 1.01; 95% CI, 1.001-1.02; P=.02) and post-treatment NT-proBNP (HR 1.02; 95% CI, 1.002-1.04; P=.04) were predictors for 1-year mortality. In the multivariable analysis, however, only baseline NT-proBNP and atrial fibrillation were identified as predictors for the 1-year mortality (HR, 1.02; 95% CI, 1.01-1.05; P=.006 and HR, 3.4; 95% CI, 1.25-9.5; P=.017, respectively).
  
  
  CONCLUSIONS
  NT-proBNP and atrial fibrillation were predictors for 1-year mortality, offer independent prognostic information, and identify patients being at increased risk for mortality. Thus, NT-proBNP reveals more incremental value for patient selection and should be included in the risk stratification of patients undergoing TAVI.
authors.affiliation: Clinic for Cardiovascular Surgery, German Heart Centre, Munich, Germany. elhmidi@dhm.mhn.de
authors.forename: Yacine
authors.initials: Y
authors.lastname: Elhmidi
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Hendrik
authors.initials: H
authors.lastname: Ruge
authors.forename: Markus
authors.initials: M
authors.lastname: Krane
authors.forename: Markus-André
authors.initials: MA
authors.lastname: Deutsch
authors.forename: Ina
authors.initials: I
authors.lastname: Hettich
authors.forename: Bernhard
authors.initials: B
authors.lastname: Voss
authors.forename: Domenico
authors.initials: D
authors.lastname: Mazzitelli
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000378:metabolism / Q000401:mortality* / Q000601:surgery*; D001281:Atrial Fibrillation / Q000378:metabolism / Q000401:mortality / Q000601:surgery; D063126:Balloon Valvuloplasty / Q000379:methods / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000378:metabolism / Q000401:mortality / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D008297:Male; D009206:Myocardium / Q000378:metabolism; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain