title: N-terminal pro-B-type natriuretic peptide-ratio predicts mortality after transcatheter aortic valve replacement.
abstract: OBJECTIVE
  We studied the prognostic value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP)-ratio, which is independent of individual cutoff levels, in predicting mortality in patients undergoing transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Elevated levels of natriuretic peptides are associated with adverse outcomes across a wide spectrum of cardiovascular diseases. However, cutoff values differ according to age, gender, and body weight.
  
  
  METHODS
  244 TAVR patients with preprocedural NT-proBNP levels were analyzed, and the predictive value of NT-proBNP-ratio (measured NT-proBNP/maximal normal NT-proBNP values specific for age and gender) on all-cause-mortality was assessed in a multivariate model.
  
  
  RESULTS
  Median NT-proBNP-ratio was 4.2 [IQR 1.8-9.7]. All-cause mortality at 30 days was 3.4% in patients with less than median NT-proBNP-ratio, and 14.0% in patients with more than median NT-proBNP-ratio (P=0.02). All-cause mortality at 1 year was 8.5% in patients with less than median NT-proBNP-ratio, and 32.1% in those with more than median NT-proBNP-ratio (P=0.001). Cumulative survival declined with increasing quartiles of NT-proBNP-ratio (log rank P=0.001). All patients with a NT-proBNP-ratio below 1.5 survived at 1-year follow-up. In ROC analysis, NT-proBNP-ratio significantly predicted 30-day (AUC=0.72; P=0.002) and 1-year all-cause mortality (AUC=0.72; P<0.001). By multivariate Cox regression analysis, NT-proBNP-ratio, chronic obstructive pulmonary disease, and serum creatinine were the only independent predictors of all-cause mortality.
  
  
  CONCLUSIONS
  Elevated NT-proBNP-ratio was associated with increased short- and long-term mortality after TAVR, and independently predicted all-cause mortality. NT-proBNP-ratio should be considered in the risk stratification of patients undergoing TAVR.
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerlan.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Stähli
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerlan.
authors.forename: Cathérine
authors.initials: C
authors.lastname: Gebhard
authors.affiliation: Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Lanja
authors.initials: L
authors.lastname: Saleh
authors.affiliation: Departement of Cardiovascular Surgery, University Heart Center, Zurich, Switzerlan.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerlan.
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerlan.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Departement of Cardiovascular Surgery, University Heart Center, Zurich, Switzerlan.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerlan.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerlan.
authors.forename: Willibald
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Cardiology, University Heart Center, Zurich, Switzerlan.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: aortic valve disease; biomarkers; percutaneous intervention; risk stratification; transcatheter valve implantation