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Left atrial volume index predicts future improvement of B-type natriuretic peptide levels after transcatheter aortic valve replacement

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Abstract

In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Furthermore, poor B-type natriuretic peptide (BNP) improvement is associated with increased morbidity and mortality. However, little is known about the clinical parameters related to the change in BNP levels after TAVR procedure. This study population consisted of 127 consecutive patients of symptomatic severe AS with preserved ejection fraction (EF) who underwent transfemoral TAVR (TF-TAVR). Comprehensive transthoracic echocardiography was performed prior to the day of TF-TAVR. BNP was measured serially before and 1 year after TF-TAVR. The median BNP level was significantly decreased from 252.5 pg/ml to 146.8 pg/ml in all 127 patients 1 year after TF-TAVR (P < 0.01). However, the patients could be divided into 2 groups according to decrease (72%) or increase (28%) in plasma BNP level. Multivariate logistic regression analysis revealed that Aortic valve (AV) peak velocity, pre-procedural BNP, and larger left atrial volume index (LAVI) were found to be an independent predictor of increased BNP level 1 year after TAVR (OR 0.55, 95% CI 0.38–0.77; P < 0.01). LAVI were negatively correlated with the change in BNP level before and 1 year after TAVR (r = 0.47, P < 0.01). The ROC analysis demonstrated that 52.9 ml/m2 was the optimal cut-off value of LAVI for decreasing BNP 1 year after TAVR (area under the curve 0.69) with 64% sensitivity and 70% specificity. In addition to AV peak velocity and pre-procedural BNP, LAVI independently predicts future improvement of BNP levels 1 year after TAVR. Our findings indicate an additive predictive value of assessment of LAVI before TAVR procedure for risk stratification.

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Acknowledgements

We thank Leah Cannon, PhD, from Edanz (https://www.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan

    Asahiro Ito, Yasuhiro Izumiya, Shinichi Iwata, Mana Ogawa, Andrew T. Kim, Ryosuke Yahiro, Yusuke Kure, Tomohiro Yamaguchi, Tsukasa Okai & Minoru Yoshiyama

  2. Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Yosuke Takahashi & Toshihiko Shibata

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  1. Asahiro Ito
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MO, ATK, RY, YK, TY, YT and TO. The first draft of the manuscript was written by AI and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Asahiro Ito.

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The authors declare that they have no conflict of interest.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Osaka City University Graduate School of Medicine (Approval Number: 2021-064).

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Informed consent was obtained from all individual participants included in the study.

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Ito, A., Izumiya, Y., Iwata, S. et al. Left atrial volume index predicts future improvement of B-type natriuretic peptide levels after transcatheter aortic valve replacement. Int J Cardiovasc Imaging 38, 1463–1471 (2022). https://doi.org/10.1007/s10554-022-02538-7

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