Periprocedural Changes of NT-proBNP Are Associated With Survival After Transcatheter Aortic Valve Implantation.

Background Cardiovascular biomarkers constitute promising tools for improved risk stratification and prediction of outcome in patients undergoing transcatheter aortic valve implantation. We examined the association of periprocedural changes of NT-proBNP (N-terminal pro-B-type natriuretic peptide) with survival after transcatheter aortic valve implantation. Methods and Results NT-proBNP levels were measured in 704 patients before transcatheter aortic valve implantation and at discharge. Patients were grouped as responders and nonresponders depending on an NT-proBNP-based ratio (postprocedural NT-proBNP at discharge/preprocedural NT-proBNP). Overall, 376 of 704 patients showed a postprocedural decrease in NT-proBNP levels (NT-proBNP ratio <1). Responders and nonresponders differed significantly regarding median preprocedural (2822 versus 1187 pg/mL, P<0.001) and postprocedural (1258 versus 3009 pg/mL, P<0.001) NT-proBNP levels. Patients in the nonresponder group showed higher prevalence of atrial fibrillation (47.0% versus 39.4%, P=0.042), arterial hypertension (94.2% versus 87.5%, P=0.002), renal impairment (77.4% versus 69.1%, P=0.013), and peripheral artery disease (24.4% versus 14.6%, P=0.001). In contrast, patients in the responder group had higher prevalence of moderately reduced left ventricular ejection fraction (17.3% versus 11.0%, P=0.017), lower calculated aortic valve area (0.7 versus 0.8 cm2, P<0.001), and higher mean pressure gradient (41 versus 35 mm Hg, P<0.001). Median follow-up was 22.6 months. Kaplan-Meier analysis showed a highly significant survival benefit for the responder group compared with the nonresponder group (log-rank test, P<0.001). Conclusions A ratio based on periprocedural changes of NT-proBNP is a simple tool for better risk stratification and is associated with survival in patients after transcatheter aortic valve implantation.

Incidence and impact of prosthesis-patient mismatch following transcatheter aortic valve implantation.

INTRODUCTION: The implications of prosthesis-patient mismatch (PPM) in the context of transcatheter aortic valve implantation (TAVI) are still controversial. The objective of our study was thus to investigate the incidence and prognostic impact of PPM after TAVI. METHODS: Our analysis included 613 TAVI patients in whom the indexed effective orifice area (iEOA) after TAVI was obtained in vivo using echocardiography. Prosthesis sizing was guided by pre-procedural ECG-gated computed tomography. Based on VARC-2 established criteria for significant PPM (iEOA ≤ 0.85 cm2/m2 in the setting of BMI < 30 kg/m2 and iEOA ≤ 0.7 cm2/m2 in the context of BMI ≥ 30 kg/m2), patients were attributed to a "No PPM" or a "PPM" group. RESULTS: We observed PPM after TAVI in 192 patients (31.3%) with moderate PPM being present in 150 subjects (24.5%) and severe PPM in 42 patients (6.9%). EuroSCORE, impaired LV function, and male gender were associated with PPM status. The "No PPM" group was characterized by higher rates of self-expandable valves (40.4% vs. 25.5%, p < 0.001). In a multivariate analysis age > 81.2 years, chronic obstructive pulmonary disease, peripheral artery disease, impaired LV function, acute kidney failure stage 3 as well as periprocedural myocardial infarction emerged as independent risk predictors for all-cause mortality after TAVI. After a median follow-up of 12.2 months PPM failed to show a significant association with overall survival (79.2% vs. 79.3%, p = 0.692). CONCLUSIONS: The incidence of PPM after TAVI seems to be substantially lower than after SAVR. PPM was less common using self-expandable valves. In our analysis, patients with PPM following TAVI did not have higher rates of all-cause mortality.