Zhou Yaoyao, Zhu Qifeng, Hu Po, Li Huajun, Lin Xinping, Liu Xianbao, Pu Zhaoxia, Wang Jian'an
Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Cardiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
Front Cardiovasc Med. 2023 Feb 17;10:1098764. doi: 10.3389/fcvm.2023.1098764. eCollection 2023.
There are only limited reports on the trends of NT-proBNP after transcatheter aortic valve replacement (TAVR) in aortic stenosis (AS) and even fewer report on the prognostic value of the NT-proBNP trajectory following TAVR.
This study aims to investigate short-term NT-proBNP trajectory following TAVR and explore its association with clinical outcomes in TAVR recipients.
Aortic stenosis patients undergoing TAVR were included if they had NT-proBNP levels recorded at baseline, prior to discharge, and within 30 days after TAVR. We used latent class trajectory models to identify NT-proBNP trajectories based on their trends over time.
Three distinct NT-proBNP trajectories were identified from 798 TAVR recipients, which were named class 1 ( = 661), class 2 ( = 102), and class 3 ( = 35). Compared to those with trajectory class 1, patients with trajectory class 2 had a more than 2.3-fold risk of 5-year all-cause death and 3.4-fold risk of cardiac death, while patients with trajectory class 3 had a more than 6.6-fold risk of all-cause death and 8.8-fold risk of cardiac death. By contrast, the groups had no differences in 5-year hospitalization rates. In multivariable analyses, the risk of 5-year all-cause mortality was significantly higher in patients with trajectory class 2 (HR 1.90, 95% CI 1.03-3.52, = 0.04) and class 3 (HR 5.70, 95% CI 2.45-13.23, < 0.01).
Our findings implied different short-term evolution of NT-proBNP levels in TAVR recipients and its prognostic value for AS patients following TAVR. NT-proBNP trajectory may have further prognostic value, in addition to its baseline level. This may aid clinicians with regards to patient selection and risk prediction in TAVR recipients.
关于经导管主动脉瓣置换术（TAVR）治疗主动脉瓣狭窄（AS）后N末端B型利钠肽原（NT-proBNP）变化趋势的报道有限，而关于TAVR后NT-proBNP变化轨迹的预后价值的报道更少。
本研究旨在探讨TAVR后短期NT-proBNP变化轨迹，并探讨其与TAVR受者临床结局的关系。
纳入接受TAVR的主动脉瓣狭窄患者，这些患者在基线、出院前和TAVR后30天内记录了NT-proBNP水平。我们使用潜在类别轨迹模型根据NT-proBNP随时间的变化趋势来确定其轨迹。
从798例TAVR受者中确定了三种不同的NT-proBNP轨迹，分别命名为1类（n = 661）、2类（n = 102）和3类（n = 35）。与1类轨迹患者相比，2类轨迹患者5年全因死亡风险高出2.3倍以上，心脏死亡风险高出3.4倍，而3类轨迹患者全因死亡风险高出6.6倍以上，心脏死亡风险高出8.8倍。相比之下，各组5年住院率无差异。在多变量分析中，2类轨迹患者（HR 1.90，95%CI 1.03 - 3.52，P = 0.04）和3类轨迹患者（HR 5.70，95%CI 2.45 - 13.23，P < 0.01）5年全因死亡率风险显著更高。
我们的研究结果表明TAVR受者NT-proBNP水平的短期变化不同，及其对TAVR后AS患者的预后价值。除基线水平外，NT-proBNP轨迹可能具有进一步的预后价值。这可能有助于临床医生对TAVR受者进行患者选择和风险预测。
