Abstract 18222: Prognostic Value of B-type Natriuretic Peptide in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
We retrospectively evaluated B-type natriuretic peptide (BNP) level, various clinical and echo-Doppler parameters to predict 1year mortality in 150 patients who underwent either transfemoral (TF) or transapical (TA) transcatheter aortic valve replacement (TAVR) at a single US center. Mean Age was 85±8 years, 56% male, STS score 11±4, NYHA 3.6±0.5, aortic valve area (AVA) 0.8±0.4, Vmax 4.2±0.8, mean AV pressure gradient (MPG) 48±35, LV ejection fraction (LVEF) 56±16, and PAP 45±17, BNP 681±739. Patients with BNP ≥400pg/mL (n=81) vs. BNP<400 (n=69) had: creatinine >2 (25% vs 12%, p=0.01), LVEF (49±15 vs. 63±12, p<0.001), mitral deceleration time (33% vs. 16%, p=0.039, tissue Doppler S velocity (5.3±1.4 vs. 6.4±1.3, p<0.001), left atrial (LA) volume (100±32 vs. 89±27, p=0.052), MR >2+ (25% vs. 7%, p=0.005), and CVP >10 (43% vs. 22%, p=0.018) (Table). TA-TAVR was performed in 27% of pts with BNP ≥400 and 20% of pts with BNP <400. Pts with BNP ≥400 had higher 1 year mortality: 41% vs. 14% in TF-TAVR group, and 41% vs. 29% in TA-TAVR group (p=0.002, Figure). Univariate predictors of 1 year mortality were: male gender, frailty, smoking, prior MI, creatinine >2, BNP >400, PAP ≥50, CVP >10, LV end systolic size, LA volume, baseline MR >moderate; and post procedural improvement in NYHA (Table). In Cox regression analysis significant predictors of 1 year mortality were: BNP >400 (HR 3.5, CI 1.2-11, p=0.036), PAP >50 (HR 2.2, CI 1.2-4.2, p=0.014), and CVP >10 (HR 3.2, CI 1.3-8, p=0.014). Heart failure status as evident by BNP, PAP, and CVP are independent predictors of 1 year mortality after TAVR. Further studies are needed to assess the impact of optimizing heart failure status on outcomes after TAVR.
- © 2012 by American Heart Association, Inc.