Introduction: Transcatheter aortic valve replacement (TAVR) is a well-established treatment option in high-risk and selected intermediate-risk patients with severe aortic stenosis. Cardiovascular biomarkers might represent promising tools for better risk stratification and prediction of long-term survival. We examined the impact of periprocedural changes in N-terminal pro B-type natriuretic peptide (NT-proBNP) on long-term survival in patients undergoing TAVR.
Methods: 725 patients who underwent TAVR at our center between 01/2011 and 03/2017 were analysed. NT-proBNP levels were measured before (1-3 days) and after (3-7 days, depending on the discharge date) successful TAVR. Follow-up data were obtained after 6 and 12 months and annually thereafter. An individual decrease of NT-proBNP levels after TAVR was defined as response, while an increase was defined as non-response.
Results: 387 out of 725 patients showed a post-procedural decrease in NT-proBNP levels and were thus defined as treatment responders. Responders and non-responders did differ significantly regarding pre-procedural NT-proBNP levels (5250 ± 9352 pg/ml vs. 2784 ± 5783 pg/ml, p < 0.0001) and the prevalence of atrial fibrillation (39.64% vs. 46.90%, p = 0.049). Median follow-up was 27.6 months. Kaplan-Meier analysis showed a significant long-term survival benefit of the responder group compared to the non-responder group.
Conclusion: Patients with an acute decrease of circulating NT-proBNP levels after successful TAVR showed a superior long-term outcome over patients with an increase. NT-proBNP is a promising biomarker for better risk stratification and prediction of long-term survival in patients undergoing TAVR and might aid in monitoring treatment response.