Natriuretic peptide dynamics predict long-term mortality and left ventricular functional recovery after transcatheter aortic valve implantation
F A Wenzl, P Wang, P Savvoulidis, Q Chen, T Al-Och, Y Yakupoglu, S Davies, M Dalby, T Kabir, V Panoulas, S Mirsadraed, A P Kalogeropoulos, F C Tanner, T LuescherAbstract
Background
Current guidelines recommend evaluating signs suggestive for valve dysfunction within the first year after transcatheter aortic valve implantation (TAVI). However, the prognostic value of natriuretic peptides and their trajectories for mortality and left ventricular functional recovery has remained unclear.
Purpose
We aimed to evaluate the prognostic impact of baseline levels and dynamic changes of brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) on all-cause mortality and left ventricular ejection fraction (LVEF) recovery following TAVI.
Methods
We analysed 1,373 patients from three European cohorts. BNP (UK cohort) and NT-proBNP (Swiss and German cohorts) were measured at baseline and during follow-up. Biomarker levels were analysed on a continuous (log-transformed) and a categorical (high vs. low) scale. Long-term mortality was assessed in the Swiss (median follow-up 3.7 years) and UK (median follow-up 5.1 years) cohorts using Cox models. In the German cohort, LVEF changes from 7 days to 1 year were analysed using linear regression.
Results
On multivariable-adjustment for clinical characteristics, baseline natriuretic peptide levels independently predicted mortality in the Swiss cohort (hazard ratio [HR] per log2 increase 1.22, 95% confidence interval [CI] 1.13–1.31, P < 0.001) and in the UK cohort (HR 1.17, 95% CI 1.02–1.34, P = 0.023). Patients with persistently high levels (high/high vs. low/low) exhibited a significantly increased risk of long-term mortality in both cohorts (Swiss cohort: HR 1.99, 95% CI 1.45–2.74, P < 0.001; UK cohort: HR 2.18, 95% CI 1.14–4.17, P = 0.019; Figure 1 and Figure 2, top). Furthermore, in the German cohort, both baseline levels (β 1.10, 95% CI 0.26–1.94, P = 0.011) and dynamic changes (β 4.41, 95% CI 0.90–7.92, P = 0.015; Figure 2, bottom) were independently associated with impaired LVEF recovery from 7 days to 1 year.
Conclusion
Monitoring BNP/NT-proBNP dynamics is essential for post-TAVI risk stratification. Persistent biomarker elevation is a powerful predictor of both increased mortality and poor functional recovery, aiding in personalised patient management.Mortality in pooled data (UK & Switzerland)Analysis summary on BNP/NT-proBNP dynamics