Abstract 13965: Utility on Right Heart Catheterization and NTproBNP-Levels for Riskstratification in Patients Treated by Transcatheter Aortic Valve Implantation (TAVI)
Introduction: TAVI is a new treatment option for high-risk patients with severe aortic valve stenosis (AVS). Risk-stratification is still an important and insufficiently explored issue. The objective of this study was to determine whether peri-procedural right heart catheterization and the changes in NTproBNP secretion can provide useful information about patient outcome.
Methods: A total of 259 patients (age: 80±7; m/f: 116/143; average lgES: 24±15,8%) with severe AVS were treated by TAVI (CoreValve n=189, EdwardsSAPIEN n=70). Transvalvular hemodynamics in addition to cardiac output (CO), pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP) were monitored by SwanGanz-catheter (SG) before and after TAVI. NTproBNP was sampled before TAVI, right after TAVI, at 6 weeks and 6 months, respectively.
Results: Procedural success rate was 97% and 30-day mortality was 8% (cardiac cause: 3%, non-cardiac cause: 5%). With regard to six-month follow-up an increased mortality could be demonstrated in patients with a post-procedural CO ≤ 3.5 L/min (CO ≤ 3.5 L/min vs. 3.5-5 L/min vs. ≥ 5 L/min - 70% vs. 90% vs. 98%, respectively, Fig. 01). In addition, any rise in PCWP (delta > 0 mmHg vs. ≤ 0 mmHg) demonstrated to be associated with increased risk in mortality (81% vs. 94%). Furthermore, a rise in PCWP was associated with higher NTproBNP-levels compared to patients with a declining PCWP. A cut off with a post-procedural rise in NTproBNP by ≥ 1500ng/L could be calculated to be highly predictive for adverse outcome (mortality for an increase in NTproBNP ≥ 1500ng/L vs. < 1500ng/L: 66% vs. 91%).
Conclusion: Right heart catheterization is a valuable tool providing prognostically useful information during TAVI. A post-procedural CO ≤ 3,5 L/min and any rise in post-procedural PCWP that is likely to be accompanied by a significant increase in NTproBNP seem to indicate patients in increased risk of mortality. These patients need a more intensive monitoring/treatment.
- © 2011 by American Heart Association, Inc.