title: Does residual aortic regurgitation after transcatheter aortic valve implantation increase mortality in all patients? The importance of baseline natriuretic peptides.
abstract: BACKGROUND
  Aortic regurgitation (AR) is an important complication of transcatheter aortic valve implantation (TAVI) and even moderate AR is associated with increased mortality after TAVI. The association with decreased survival is unclear. We aimed to analyse the impact of AR after TAVI as a function of baseline NT-proBNP.
  
  
  METHODS
  We included 236 consecutive patients implanted in our centre with the SAPIEN and SAPIEN XT valves, via the transfemoral route. AR was evaluated by transthoracic echocardiography. NT-proBNP was measured 24h before implantation and patients were divided according to the median value.
  
  
  RESULTS
  Median age was 85 years (80-89) and 137 (58.1%) were women. Patients with high NT-proBNP had lower left ventricular ejection fraction: 52% (35-65) vs. 63% (55-70), p<0.001, larger telediastolic diameters: 56 mm (49-61) vs. 52 mm (46-56), p=0.01, and more severe aortic stenosis: 0.62 ± 0.15 cm(2) vs. 0.70 ± 0.2 cm(2), p<0.001. Pre-procedural moderate or severe AR (42% vs. 26%, p=0.013) and mitral regurgitation (56% vs. 36%, p=0.004) were more common in the high NT-proBNP group. After TAVI, moderate or severe AR occurred in 26% of patients and was associated with increased 2-year mortality only in the low NT-proBNP group, while patients in the high NT-proBNP group were not affected.
  
  
  CONCLUSIONS
  Moderate or severe AR after TAVI was not associated with increased 2-year mortality in patients with high baseline NT-proBNP. Our data suggest that the impact of AR after TAVI is absent in patients with significant pre-procedural AR or mitral regurgitation and more severe aortic stenosis.
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U1096, Rouen, France. Electronic address: bogdanborz@gmail.com.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Borz
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U1096, Rouen, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Durand
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U1096, Rouen, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Godin
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U1096, Rouen, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tron
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U1096, Rouen, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Canville
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U1096, Rouen, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Hauville
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U1096, Rouen, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bauer
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U1096, Rouen, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U1096, Rouen, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
mesh_terms: D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D012042:Registries; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality* / Q000639:trends
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Aortic regurgitation; Mortality; Natriuretic peptides; TAVI