The evolution and prognostic value of N-terminal brain natriuretic peptide in predicting 1-year mortality in patients following transcatheter aortic valve implantation.

Aims. N-terminal pro-brain natriuretic peptide (NTproBNP) 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. Method and 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, preand 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. J INVASIVE CARDIOL 2013;25(1):38-44