Abstract 19271: Effect of Transcatheter Aortic Valve Implantation on Neurohumoral Activation and NYHA Functional Class
Background: Severe aortic valve stenosis often is accompanied by severe symptoms of congestive heart failure (CHF) restricting quality of life in elderly patients. Natriuretic peptides like B-type natriuretic peptide (BNP) and the N-terminal fragment (NT-proBNP) are neurohumoral factors associated with increased wall stress. We assessed the effect of transcatheter aortic valve implantation (TAVI) on neurohumoral activation and functional class.
Methods and Results: This prospective study included 72 patients (64% females; age 83 ± 5 years) with severe aortic stenosis (AVA=0.6±0.2cm2; pmean=46±15mmHg) undergoing TAVI with a Medtronic CoreValve bioprosthesis (n=62) or an Edwards Sapien Valve (n=10). Baseline characteristics showed a mean logistic EuroScore of 22.3±14.7%, 39 patients (54%) had preexisting coronary artery disease, 8 (11%) chronic obstructive pulmonary disease, 50 (69%) arterial hypertension and 16 patients (22%) diabetes mellitus. Levels of the neurohumoral factors BNP and NT- proBNP were measured 1.6±2 days before TAVI and at discharge 6.9±3 days after TAVI. Levels were significantly lower after the intervention and left ventricular ejection fraction improved compared to baseline measurements (Table 1). Short-term clinical follow up (mean 41±16 days after TAVI) revealed an improvement of NYHA functional class (mean 2.6±0.9 vs. 1.4 ± 0.8, p<0.001)
Conclusion: Transcatheter aortic valve implantation results in a rapid decrease in neurohumoral activation, which is associated with an improvement of left ventricular function and symptoms of CHF.
- © 2010 by American Heart Association, Inc.