Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Am J Cardiol. 2014 Mar 1;113(5):851-9. doi: 10.1016/j.amjcard.2013.11.038. Epub 2013 Dec 12.
Little is known about the usefulness of evaluating cardiac neurohormones in patients undergoing transcatheter aortic valve implantation (TAVI). The objectives of this study were to evaluate the baseline values and serial changes of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) after TAVI, its related factors, and prognostic value. A total of 333 consecutive patients were included, and baseline, procedural, and follow-up (median 20 months, interquartile range 9 to 36) data were prospectively collected. Systematic NT-proBNP measurements were performed at baseline, hospital discharge, 1, 6, and 12 months, and yearly thereafter. Baseline NT-proBNP values were elevated in 86% of the patients (median 1,692 pg/ml); lower left ventricular ejection fraction and stroke volume index, greater left ventricular mass, and renal dysfunction were associated with greater baseline values (p <0.01 for all). Higher NT-proBNP levels were independently associated with increased long-term overall and cardiovascular mortalities (p <0.001 for both), with a baseline cut-off level of ∼2,000 pg/ml best predicting worse outcomes (p <0.001). At 6- to 12-month follow-up, NT-proBNP levels had decreased (p <0.001) by 23% and remained stable up to 4-year follow-up. In 39% of the patients, however, there was a lack of NT-proBNP improvement, mainly related to preprocedural chronic atrial fibrillation, lower mean transaortic gradient, and moderate-to-severe mitral regurgitation (p <0.01 for all). In conclusion, most patients undergoing TAVI presented high NT-proBNP levels, and a lack of improvement was observed in >1/3 of the patients after TAVI. Also, higher NT-proBNP levels predicted greater overall and cardiac mortalities at a median follow-up of 2 years. These findings support the implementation of NT-proBNP measurements for the clinical decision-making process and follow-up of patients undergoing TAVI.
关于在接受经导管主动脉瓣植入术（TAVI）的患者中评估心神经激素的有用性知之甚少。本研究的目的是评估 TAVI 后 N 端脑利钠肽前体（NT-proBNP）的基线值和系列变化、相关因素及其预后价值。共纳入 333 例连续患者，前瞻性收集基线、手术和随访（中位数 20 个月，四分位距 9 至 36）数据。在基线、出院时、1、6 和 12 个月以及此后每年进行系统的 NT-proBNP 测量。86%的患者基线 NT-proBNP 值升高（中位数 1692pg/ml）；较低的左心室射血分数和每搏量指数、较大的左心室质量和肾功能障碍与较大的基线值相关（所有 p<0.01）。较高的 NT-proBNP 水平与长期全因和心血管死亡率增加独立相关（两者均 p<0.001），基线截断值约 2000pg/ml 最佳预测较差结局（p<0.001）。在 6 至 12 个月的随访中，NT-proBNP 水平下降（p<0.001）23%，并在 4 年随访时保持稳定。然而，在 39%的患者中，NT-proBNP 水平无改善，主要与术前慢性心房颤动、较低的平均跨主动脉梯度和中度至重度二尖瓣反流有关（所有 p<0.01）。总之，大多数接受 TAVI 的患者呈现出高 NT-proBNP 水平，并且在 TAVI 后 >1/3 的患者中观察到缺乏改善。此外，较高的 NT-proBNP 水平预测了中位随访 2 年后更大的全因和心脏死亡率。这些发现支持为 TAVI 患者的临床决策过程和随访实施 NT-proBNP 测量。
