Kaneko Hidehiro, Hoelschermann Frank, Tambor Grit, Okamoto Maki, Neuss Michael, Butter Christian
Department of Cardiology, Heart Center Brandenburg, Bernau, Germany.
Department of Cardiology, Brandenburg Medical School (MHB), Ladeburger Straße 17, 16321, Bernau, Germany.
Heart Vessels. 2019 May;34(5):777-783. doi: 10.1007/s00380-018-1297-z. Epub 2018 Nov 15.
N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels prior to transcatheter aortic valve implantation (TAVI) are known to be associated with outcomes of patients undergoing TAVI. However, little has been known about the NT-proBNP response after TAVI. Therefore, we aimed to clarify the role of the NT-proBNP response and identify the determinants of the NT-proBNP nonresponse among patients with severe aortic stenosis (AS) and heart failure (HF) undergoing TAVI. We examined 717 patients with severe AS and HF undergoing TAVI. NT-proBNP nonresponders were defined as patients whose NT-proBNP levels decreased by ≤ 30%. Mean NT-proBNP levels decreased from 7698 ± 7853 pg/mL (baseline) to 4523 ± 5173 pg/mL (post-TAVI); 269 patients (38%) were nonresponders. Female gender and prevalence of diabetes mellitus (DM), chronic kidney disease (CKD), atrial fibrillation (AF), and history of coronary artery revascularization were more common for NT-proBNP nonresponders. Permanent pacemaker implantation rate was higher for NT-proBNP nonresponders. In addition to the baseline NT-proBNP level > 7500 pg/smL (hazard ratio [HR], 1.8; p = 0.03), NT-proBNP nonresponse (HR 2.3; p = 0.001) was associated with lower survival rates. Baseline NT-proBNP level ≤ 7500 pg/mL (OR 3.2; p < 0.001), female gender (odds ratio [OR], 1.5; p = 0.049), DM (OR 1.6; p = 0.016), CKD (OR 1.8; p = 0.001), AF (OR 2.4; p < 0.001), history of coronary revascularization (OR 1.7; p = 0.003), and permanent pacemaker implantation after TAVI (OR 1.7; p = 0.034) were independent determinants of NT-proBNP nonresponse. In "conclusion", NT-proBNP response is important for long-term survival after TAVI. We should consider the aforementioned determinants, particularly permanent pacemaker implantation, as risk factors for NT-proBNP nonresponse.
经导管主动脉瓣植入术（TAVI）前N端前B型利钠肽（NT-proBNP）水平已知与接受TAVI患者的预后相关。然而，关于TAVI后NT-proBNP的反应知之甚少。因此，我们旨在阐明NT-proBNP反应的作用，并确定接受TAVI的重度主动脉瓣狭窄（AS）和心力衰竭（HF）患者中NT-proBNP无反应的决定因素。我们研究了717例接受TAVI的重度AS和HF患者。NT-proBNP无反应者定义为NT-proBNP水平下降≤30%的患者。NT-proBNP平均水平从7698±7853 pg/mL（基线）降至4523±5173 pg/mL（TAVI后）；269例患者（38%）为无反应者。NT-proBNP无反应者中女性以及糖尿病（DM）、慢性肾脏病（CKD）、心房颤动（AF）的患病率和冠状动脉血运重建史更为常见。NT-proBNP无反应者永久起搏器植入率更高。除了基线NT-proBNP水平>7500 pg/smL（风险比[HR]，1.8；p=0.03）外，NT-proBNP无反应（HR 2.3；p=0.001）与较低的生存率相关。基线NT-proBNP水平≤7500 pg/mL（比值比[OR]，3.2；p<0.001）、女性（OR，1.5；p=0.049）、DM（OR 1.6；p=0.016）、CKD（OR 1.8；p=0.001）、AF（OR 2.4；p<0.001）、冠状动脉血运重建史（OR 1.7；p=0.003）以及TAVI后永久起搏器植入（OR 1.7；p=0.034）是NT-proBNP无反应的独立决定因素。总之，NT-proBNP反应对TAVI后的长期生存很重要。我们应将上述决定因素，尤其是永久起搏器植入，视为NT-proBNP无反应的危险因素。
