Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel,
The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel,
Cardiology. 2020;145(12):813-821. doi: 10.1159/000509857. Epub 2020 Oct 16.
Risk stratification in patients post-transcatheter aortic valve replacement (TAVR) is limited to and is based on clinical judgment and surgical scoring systems. Serum natriuretic peptides are used for general risk stratification in patients with aortic stenosis, reflecting the increase in their afterload and thereby stressing the need for valve intervention. The objective of this study was to determine the predictive value of pre- and post-procedural serum brain natriuretic peptide (BNP) on 1-year all-cause mortality in patients who underwent TAVR.
In this population-based study, we included 148 TAVR patients treated at the Poriya Medical Center between June 1, 2015, and May 31, 2018. Routine blood samples for serum BNP levels (pg/mL) were taken just before the TAVR and 24 h post-TAVR. Our primary clinical outcome was defined as 1-year all-cause mortality. We used backward regression models and included all variables that had a p value <0.1 in the univariable analysis. A receiver-operating characteristic curve was calculated for the prediction of all-cause mortality by serum BNP levels using the median as the cut-off point.
In this study cohort, BNP levels 24 h post-TAVR higher than the cohort median versus lower than the cohort median (387.5 pg/mL; IQR 195-817.6) were the strongest predictor of 1-year mortality (hazard ratio 9; 95% CI 2.72-30.16; p < 0.001). The statistically significant relationship was seen in the unadjusted regression model as well as after the adjustment for clinical variables.
Serum BNP levels 24 h post-procedure were found to be a meaningful marker in predicting 1-year all-cause mortality in patients after TAVR procedure.
经导管主动脉瓣置换术（TAVR）后患者的风险分层仅限于临床判断和手术评分系统。血清利钠肽用于主动脉瓣狭窄患者的一般风险分层，反映其后负荷增加，从而强调需要进行瓣膜干预。本研究的目的是确定 TAVR 术后患者术前和术后血清脑利钠肽（BNP）水平对 1 年全因死亡率的预测价值。
在这项基于人群的研究中，我们纳入了 2015 年 6 月 1 日至 2018 年 5 月 31 日在波里亚医疗中心接受 TAVR 治疗的 148 例 TAVR 患者。在 TAVR 前和 TAVR 后 24 小时采集常规血样，检测血清 BNP 水平（pg/ml）。我们的主要临床结局定义为 1 年全因死亡率。我们使用向后回归模型，并纳入单变量分析中 p 值<0.1 的所有变量。计算血清 BNP 水平预测全因死亡率的受试者工作特征曲线，以中位数作为截断点。
在本研究队列中，TAVR 后 24 小时 BNP 水平高于队列中位数（387.5pg/ml；IQR 195-817.6）与低于队列中位数（387.5pg/ml；IQR 195-817.6）相比，是 1 年死亡率的最强预测因素（危险比 9；95%CI 2.72-30.16；p<0.001）。在未调整的回归模型中以及在调整临床变量后，都观察到了这种统计学显著的关系。
TAVR 术后 24 小时的血清 BNP 水平被发现是预测 TAVR 术后 1 年全因死亡率的有意义标志物。
