Long-Term Prognostic Value and Serial Changes of Plasma N-Terminal Prohormone B-Type Natriuretic Peptide in Patients Undergoing Transcatheter Aortic Valve Implantation
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- 作者：Henrique B. Ribeiro ; Marina Urena ; Florent Le Ven ; Luis Nombela-Franco ; Ricardo Allende ; Marie-Annick Clavel ; Abdellaziz Dahou ; M茅lanie C么t茅 ; Jer么me Laflamme ; Louis Laflamme ; Hugo DeLarochelli猫re ; Robert DeLarochelli猫re ; Daniel Doyle ; 脡ric Dumont ; Sebastien Bergeron ; Philippe Pibarot ; Josep Rod茅s-Cabau
- 刊名：The American Journal of Cardiology
- 出版年：1 March, 2014
- 年：2014
- 卷：113
- 期：5
- 页码：851-859
- 全文大小：1194 K
文摘
Little is known about the usefulness of evaluating cardiac neurohormones in patients undergoing transcatheter aortic valve implantation (TAVI). The objectives of this study were to evaluate the baseline values and serial changes of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) after TAVI, its related factors, and prognostic value. A total of 333 consecutive patients were included, and baseline, procedural, and follow-up (median 20聽months, interquartile range 9 to 36) data were prospectively collected. Systematic NT-proBNP measurements were performed at baseline, hospital discharge, 1, 6, and 12聽months, and yearly thereafter. Baseline NT-proBNP values were elevated in 86% of the patients (median 1,692 pg/ml); lower left ventricular ejection fraction and stroke volume index, greater left ventricular mass, and renal dysfunction were associated with greater baseline values (p <0.01 for all). Higher NT-proBNP levels were independently associated with increased long-term overall and cardiovascular mortalities (p <0.001 for both), with a baseline cut-off level of 鈭?,000 pg/ml best predicting worse outcomes (p <0.001). At 6- to 12-month follow-up, NT-proBNP levels had decreased (p <0.001) by 23% and remained stable up to 4-year follow-up. In 39% of the patients, however, there was a lack of NT-proBNP improvement, mainly related to preprocedural chronic atrial fibrillation, lower mean transaortic gradient, and moderate-to-severe mitral regurgitation (p <0.01 for all). In conclusion, most patients undergoing TAVI presented high NT-proBNP levels, and a lack of improvement was observed in >1/3 of the patients after TAVI. Also, higher NT-proBNP levels predicted greater overall and cardiac mortalities at a median follow-up of 2聽years. These findings support the implementation of NT-proBNP measurements for the clinical decision-making process and follow-up of patients undergoing TAVI.