Early changes in N-terminal pro-B-type natriuretic peptide levels after transcatheter aortic valve replacement and its impact on long-term mortality.

Autor: Liebetrau C; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany. Electronic address: c.liebetrau@kerckhoff-klinik.de., Gaede L; St. Johannes Hospital, Dept. of Cardiology, Dortmund, Germany., Kim WK; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany., Arsalan M; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany., Blumenstein JM; St. Johannes Hospital, Dept. of Cardiology, Dortmund, Germany., Fischer-Rasokat U; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany., Wolter JS; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany., Kriechbaum S; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany., Huber MT; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany., van Linden A; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany., Berkowitsch A; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany., Dörr O; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany., Nef H; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany., Hamm CW; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Medical Clinic II, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany., Walther T; DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany., Möllmann H; St. Johannes Hospital, Dept. of Cardiology, Dortmund, Germany.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2018 Aug 15; Vol. 265, pp. 40-46.
DOI: 10.1016/j.ijcard.2018.02.037
Abstrakt: Background: N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) levels correlate with higher peri-procedural mortality after transcatheter aortic valve replacement (TAVR). The long-term prognostic value of NT-proBNP within the first days after TAVR, however, remains unclear. This study examined early changes in NT-proBNP prior to and within 6 days after TAVR, the diagnostic value of this biomarker regarding aortic regurgitation (AR), and its prognostic value regarding one-year mortality.
Methods and Results: NT-proBNP concentrations were measured in 504 consecutive patients undergoing transapical (TA) or transfemoral (TF) TAVR before and directly after TAVR as well as 4 h and 1, 2, 3, and 6 days after TAVR. The follow-up period was 1 year. NT-proBNP was elevated in all patients at baseline (median 2141 ng/L [IQR 1021-5319 ng/L]). NT-proBNP changes in the first 6 days after TAVR showed significant differences depending on the approach, with a greater and more prolonged rise evident in TA-TAVR patients. NT-proBNP was an independent predictor of mortality in TA patients with AR, with an AUC of 0.794 (95% CI 0.663-0.925; P = 0.003) when measured on day 3 after TAVR. For TF patients with AR and reduced left ventricular systolic function, the AUC for prediction of mortality was 0.897 (95% CI 0.778-1.0; P = 0.004) on day 2.
Conclusions: The prognostic information of early post-procedural NT-proBNP concentrations is superior to pre-procedural values regarding all-cause mortality within 1 year. Post-procedural NT-proBNP must be interpreted in relation to the TAVR approach. NT-proBNP predicts mortality in TF-TAVR patients with AR and reduced left ventricular function.
(Copyright © 2018 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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