Abstract 4371: Increase in B-Type Natriuretic Peptide at 24 Hours Predicts 30-day Survival After Transcatheter Aortic Valve Implantation
Background: B-type natriuretic peptide (BNP) has been shown to predict outcome after conventional aortic valve replacement (AVR). The aim of the present study was to investigate whether BNP also predicts outcome after transcatheter aortic valve implantation (TAVI).
Methods: Since January 2008, 33 pts (21 males, 85±5 years, mean LVEF 43±14%) with severe aortic stenosis (valve area: 0,6±0,1 cm2; mean gradient: 42±15 mmHg) who were considered to be at high risk for conventional AVR (EuroScore: 36±16%) underwent TAVI at our institution. BNP was measured using the Biosite triage meter system before TAVI, as well as 24 hours after TAVI.
Results: 30-day survival was 87%. Although baseline clinical and hemodynamic characteristics were similar among 30-day survivors (n=29) and non-survivors (n=4), BNP levels were significantly lower in the 30-day survivors, both at baseline (533±509 vs 1081±1127 pg/mL; p=0.04) and 24 hours after TAVI (549±358 vs 1832±1481 pg/mL; p<0.0005). Increases in BNP from baseline to 24 hours were also lower in survivors compared to non-survivors (32±283 vs 752±391 pg/mL; p<0.0001). At 24 hours, BNP (717±702 pg/ml) correlated well with peak troponin-I levels (4.9±7.4 ng/mL; r=0.77). With multivariate analysis, the increase in BNP from baseline to 24 hours was the only independent predictor of 30-day mortality (HR: 1.007; 95% CI: 1.002–1.012; p=0,004). Kaplan-Meier survival analysis showed that 30-day survival was significantly lower in pts (group I) with than in those without (group II) significant BNP increases at 24 hours (p=0,005).
Conclusions: Increase in BNP levels 24 hours after TAVI is a strong predictor of 30-day survival.