title: Long-term prognostic value and serial changes of plasma N-terminal prohormone B-type natriuretic peptide in patients undergoing transcatheter aortic valve implantation.
abstract: 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 N-terminal prohormone B-type natriuretic peptide (NT-proBNP) after TAVI, its related factors, and prognostic value. A total of 333 consecutive patients were included, and baseline, procedural, and follow-up (median 20 months, interquartile range 9 to 36) data were prospectively collected. Systematic NT-proBNP measurements were performed at baseline, hospital discharge, 1, 6, and 12 months, and yearly thereafter. Baseline NT-proBNP values were elevated in 86% of the patients (median 1,692 pg/ml); lower left ventricular ejection fraction and stroke volume index, greater left ventricular 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 mortalities (p <0.001 for both), with a baseline cut-off level of ∼2,000 pg/ml best predicting worse outcomes (p <0.001). At 6- to 12-month follow-up, NT-proBNP levels had decreased (p <0.001) by 23% and remained stable up to 4-year follow-up. In 39% of the patients, however, there was a lack of NT-proBNP improvement, mainly related to preprocedural chronic atrial fibrillation, lower mean transaortic gradient, and moderate-to-severe mitral regurgitation (p <0.01 for all). In conclusion, most patients undergoing TAVI presented high NT-proBNP levels, and a lack of improvement was observed in >1/3 of the patients after TAVI. Also, higher NT-proBNP levels predicted greater overall and cardiac mortalities at a median follow-up of 2 years. These findings support the implementation of NT-proBNP measurements for the clinical decision-making process and follow-up of patients undergoing TAVI.
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Henrique B
authors: HB
authors: Ribeiro
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Marina
authors: M
authors: Urena
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Florent
authors: F
authors: Le Ven
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Luis
authors: L
authors: Nombela-Franco
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Ricardo
authors: R
authors: Allende
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Marie-Annick
authors: MA
authors: Clavel
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Abdellaziz
authors: A
authors: Dahou
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Mélanie
authors: M
authors: Côté
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Jerôme
authors: J
authors: Laflamme
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Louis
authors: L
authors: Laflamme
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Hugo
authors: H
authors: DeLarochellière
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Robert
authors: R
authors: DeLarochellière
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Daniel
authors: D
authors: Doyle
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Eric
authors: E
authors: Dumont
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Sebastien
authors: S
authors: Bergeron
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Philippe
authors: P
authors: Pibarot
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors: Josep
authors: J
authors: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization; D003971:Diastole / Q000502:physiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000097:blood; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011498:Protein Precursors / Q000097:blood*; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain