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Impact of N-terminal pro-B-type natriuretic peptide response on long-term prognosis after transcatheter aortic valve implantation for severe aortic stenosis and heart failure

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Abstract

N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels prior to transcatheter aortic valve implantation (TAVI) are known to be associated with outcomes of patients undergoing TAVI. However, little has been known about the NT-proBNP response after TAVI. Therefore, we aimed to clarify the role of the NT-proBNP response and identify the determinants of the NT-proBNP nonresponse among patients with severe aortic stenosis (AS) and heart failure (HF) undergoing TAVI. We examined 717 patients with severe AS and HF undergoing TAVI. NT-proBNP nonresponders were defined as patients whose NT-proBNP levels decreased by ≤ 30%. Mean NT-proBNP levels decreased from 7698 ± 7853 pg/mL (baseline) to 4523 ±  5173 pg/mL (post-TAVI); 269 patients (38%) were nonresponders. Female gender and prevalence of diabetes mellitus (DM), chronic kidney disease (CKD), atrial fibrillation (AF), and history of coronary artery revascularization were more common for NT-proBNP nonresponders. Permanent pacemaker implantation rate was higher for NT-proBNP nonresponders. In addition to the baseline NT-proBNP level > 7500 pg/smL (hazard ratio [HR], 1.8; p = 0.03), NT-proBNP nonresponse (HR 2.3; p = 0.001) was associated with lower survival rates. Baseline NT-proBNP level ≤ 7500 pg/mL (OR 3.2; p < 0.001), female gender (odds ratio [OR], 1.5; p = 0.049), DM (OR 1.6; p = 0.016), CKD (OR 1.8; p = 0.001), AF (OR 2.4; p < 0.001), history of coronary revascularization (OR 1.7; p = 0.003), and permanent pacemaker implantation after TAVI (OR 1.7; p = 0.034) were independent determinants of NT-proBNP nonresponse. In “conclusion”, NT-proBNP response is important for long-term survival after TAVI. We should consider the aforementioned determinants, particularly permanent pacemaker implantation, as risk factors for NT-proBNP nonresponse.

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Acknowledgements

We thank all staff of the intervention laboratory in our institute.

Funding

This work was supported by the Japan Society for the Promotion of Science (Hidehiro Kaneko).

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Author notes

  1. Hidehiro Kaneko and Frank Hoelschermann contributed equally to this publication (share first authorship).

Authors and Affiliations

  1. Department of Cardiology, Heart Center Brandenburg, Bernau, Germany

    Hidehiro Kaneko, Frank Hoelschermann, Grit Tambor, Maki Okamoto, Michael Neuss & Christian Butter

  2. Department of Cardiology, Brandenburg Medical School (MHB), Ladeburger Straße 17, 16321, Bernau, Germany

    Hidehiro Kaneko, Frank Hoelschermann, Grit Tambor, Maki Okamoto, Michael Neuss & Christian Butter

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  1. Hidehiro Kaneko
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  2. Frank Hoelschermann
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Correspondence to Christian Butter.

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Kaneko, H., Hoelschermann, F., Tambor, G. et al. Impact of N-terminal pro-B-type natriuretic peptide response on long-term prognosis after transcatheter aortic valve implantation for severe aortic stenosis and heart failure. Heart Vessels 34, 777–783 (2019). https://doi.org/10.1007/s00380-018-1297-z

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