Heart and Vessels

, Volume 34, Issue 5, pp 777–783 | Cite as

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

  • Hidehiro Kaneko
  • Frank Hoelschermann
  • Grit Tambor
  • Maki Okamoto
  • Michael Neuss
  • Christian ButterEmail author
Original Article


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.


Transcatheter aortic valve implantation N-terminal pro-B-type natriuretic peptide Heart failure Pacemaker implantation 



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


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

Compliance with ethical standards

Conflict of interest

We have no conflict of interest for this study.


  1. 1.
    Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607CrossRefGoogle Scholar
  2. 2.
    Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198CrossRefGoogle Scholar
  3. 3.
    Biancari F, D'Errigo P, Rosato S, Pol M, Tamburino C, Ranucci M, Seccareccia F (2017) Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature. Heart Vessels 32:157–165CrossRefGoogle Scholar
  4. 4.
    Higuchi R, Tobaru T, Hagiya K, Saji M, Mahara K, Takamisawa I, Shimizu J, Takanashi S, Takayama M (2017) Transcatheter aortic valve implantation in patients on corticosteroid therapy. Heart Vessels 32:1236–1243CrossRefGoogle Scholar
  5. 5.
    Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG; PARTNER 2 Investigators (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374(17):1609–1620CrossRefGoogle Scholar
  6. 6.
    Walther T, Hamm CW, Schuler G, Berkowitsch A, Kotting J, Mangner N, Mudra H, Beckmann A, Cremer J, Welz A, Lange R, Kuck KH, Mohr FW, Mollmann H (2015) Perioperative results and complications in 15,964 transcatheter aortic valve replacements: prospective data from the GARY registry. J Am Coll Cardiol 65:2173–2180CrossRefGoogle Scholar
  7. 7.
    Seino Y, Ogawa A, Yamashita T, Fukushima M, Ogata K, Fukumoto H, Takano T (2004) Application of NT-proBNP and BNP measurements in cardiac care: a more discerning marker for the detection and evaluation of heart failure. Eur J Heart Fail 6:295–300CrossRefGoogle Scholar
  8. 8.
    Groenning BA, Raymond I, Hildebrandt PR, Nilsson JC, Baumann M, Pedersen F (2004) Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro-brain natriuretic peptide concentrations in a large sample of the general population. Heart 90:297–303CrossRefGoogle Scholar
  9. 9.
    Daniels LB, Maisel AS (2007) Natriuretic peptides. J Am Coll Cardiol 50:2357–2368CrossRefGoogle Scholar
  10. 10.
    Felker GM, Hasselblad V, Hernandez AF, O'Connor CM (2009) Biomarker-guided therapy in chronic heart failure: a meta-analysis of randomized controlled trials. Am Heart J 158:422–430CrossRefGoogle Scholar
  11. 11.
    Bergler-Klein J, Klaar U, Heger M, Rosenhek R, Mundigler G, Gabriel H, Binder T, Pacher R, Maurer G, Baumgartner H (2004) Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis. Circulation 109:2302–2308CrossRefGoogle Scholar
  12. 12.
    Pedrazzini GB, Masson S, Latini R, Klersy C, Rossi MG, Pasotti E, Faletra FF, Siclari F, Minervini F, Moccetti T, Auricchio A (2008) Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in-hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosis. Am J Cardiol 102:749–754CrossRefGoogle Scholar
  13. 13.
    Kefer J, Beauloye C, Astarci P, Renkin J, Glineur D, Dekleermaeker A, Vanoverschelde JL (2010) Usefulness of B-type natriuretic peptide to predict outcome of patients treated by transcatheter aortic valve implantation. Am J Cardiol 106:1782–1786CrossRefGoogle Scholar
  14. 14.
    Koskinas KC, O'Sullivan CJ, Heg D, Praz F, Stortecky S, Pilgrim T, Buellesfeld L, Juni P, Windecker S, Wenaweser P (2015) Effect of B-type natriuretic peptides on long-term outcomes after transcatheter aortic valve implantation. Am J Cardiol 116:1560–1565CrossRefGoogle Scholar
  15. 15.
    Abramowitz Y, Chakravarty T, Jilaihawi H, Lee C, Cox J, Sharma RP, Mangat G, Cheng W, Makkar RR (2015) Impact of PREPROCEdural B-type natriuretic peptide levels on the outcomes after transcatheter aortic valve implantation. Am J Cardiol 116:1904–1909CrossRefGoogle Scholar
  16. 16.
    Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, Pinto YM, Richards M (2006) NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: The International Collaborative of NT-proBNP Study. Eur Heart J 27:330–337CrossRefGoogle Scholar
  17. 17.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470CrossRefGoogle Scholar
  18. 18.
    Kaneko H, Neuss M, Schau T, Weissenborn J, Butter C (2017) Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip. J Cardiol 69:476–482CrossRefGoogle Scholar
  19. 19.
    Karlstrom P, Alehagen U, Boman K, Dahlstrom U (2011) Brain natriuretic peptide-guided treatment does not improve morbidity and mortality in extensively treated patients with chronic heart failure: responders to treatment have a significantly better outcome. Eur J Heart Fail 13:1096–1103CrossRefGoogle Scholar
  20. 20.
    Ribeiro A, Lourenco P, Silva S, Cunha F, Vilaca J, Gomes F, Araujo JP, Bettencourt P (2015) Predictors of natriuretic peptide non-response in patients hospitalized with acute heart failure. Am J Cardiol 115:69–74CrossRefGoogle Scholar
  21. 21.
    Kaneko H, Neuss M, Weissenborn J, Butter C (2017) Role of right ventricular dysfunction and diabetes mellitus in N-terminal pro-B-type natriuretic peptide response of patients with severe mitral regurgitation and heart failure after MitraClip. Int Heart J 58:225–231CrossRefGoogle Scholar
  22. 22.
    Kaneko H, Hoelschermann F, Schau T, Tambor G, Neuss M, Butter C (2017) Different impact of aortic regurgitation assessed by aortic root angiography after transcatheter aortic valve implantation according to baseline left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide. Cardiovasc Interv Ther. Google Scholar
  23. 23.
    Weber M, Arnold R, Rau M, Brandt R, Berkovitsch A, Mitrovic V, Hamm C (2004) Relation of N-terminal pro-B-type natriuretic peptide to severity of valvular aortic stenosis. Am J Cardiol 94:740–745CrossRefGoogle Scholar
  24. 24.
    Gerber IL, Stewart RA, Legget ME, West TM, French RL, Sutton TM, Yandle TG, French JK, Richards AM, White HD (2003) Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis. Circulation 107:1884–1890CrossRefGoogle Scholar
  25. 25.
    Mizutani K, Hara M, Iwata S, Murakami T, Shibata T, Yoshiyama M, Naganuma T, Yamanaka F, Tada N, Takagi K, Araki M, Ueno H, Tabata M, Shirai S, Watanabe Y, Yamamoto M, Hayashida K (2017) Elevation of B-type natriuretic peptide at discharge is associated with 2-year mortality after transcatheter aortic valve replacement in patients with severe aortic stenosis: insights from a multicenter prospective OCEAN-TAVI (optimized transcatheter valvular intervention-transcatheter aortic valve implantation) registry. J Am Heart Assoc 6:e006112CrossRefGoogle Scholar
  26. 26.
    Khatri PJ, Webb JG, Rodes-Cabau J, Fremes SE, Ruel M, Lau K, Guo H, Wijeysundera HC, Ko DT (2013) Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med 158:35–46CrossRefGoogle Scholar
  27. 27.
    Chevreul K, Brunn M, Cadier B, Haour G, Eltchaninoff H, Prat A, Leguerrier A, Blanchard D, Fournial G, Iung B, Donzeau-Gouge P, Tribouilloy C, Debrux JL, Pavie A, Gilard M, Gueret P (2013) Cost of transcatheter aortic valve implantation and factors associated with higher hospital stay cost in patients of the FRANCE (FRench Aortic National CoreValve and Edwards) registry. Arch Cardiovasc Dis 106:209–219CrossRefGoogle Scholar
  28. 28.
    Nazif TM, Dizon JM, Hahn RT, Xu K, Babaliaros V, Douglas PS, El-Chami MF, Herrmann HC, Mack M, Makkar RR, Miller DC, Pichard A, Tuzcu EM, Szeto WY, Webb JG, Moses JW, Smith CR, Williams MR, Leon MB, Kodali SK (2015) Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv 8:60–69CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Hidehiro Kaneko
    • 1
    • 2
  • Frank Hoelschermann
    • 1
    • 2
  • Grit Tambor
    • 1
    • 2
  • Maki Okamoto
    • 1
    • 2
  • Michael Neuss
    • 1
    • 2
  • Christian Butter
    • 1
    • 2
    Email author
  1. 1.Department of CardiologyHeart Center BrandenburgBernauGermany
  2. 2.Department of CardiologyBrandenburg Medical School (MHB)BernauGermany

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