Baseline NT‐proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation

BACKGROUND: Up to 30% of patients undergoing transcatheter aortic valve implantation (TAVI) experience minimal symptomatic benefit or die within 1 year, indicating an urgent need for enhanced patient selection. Previous analyses of baseline NT‐proBNP (N‐terminal pro‐brain natriuretic peptide) and TA...

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Autores principales: Allen, Christopher J., Joseph, Jubin, Patterson, Tiffany, Hammond‐Haley, Matthew, McConkey, Hannah Z. R., Prendergast, Bernard D., Marber, Michael, Redwood, Simon R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763793/
https://www.ncbi.nlm.nih.gov/pubmed/33241754
http://dx.doi.org/10.1161/JAHA.120.017574
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author Allen, Christopher J.
Joseph, Jubin
Patterson, Tiffany
Hammond‐Haley, Matthew
McConkey, Hannah Z. R.
Prendergast, Bernard D.
Marber, Michael
Redwood, Simon R.
author_facet Allen, Christopher J.
Joseph, Jubin
Patterson, Tiffany
Hammond‐Haley, Matthew
McConkey, Hannah Z. R.
Prendergast, Bernard D.
Marber, Michael
Redwood, Simon R.
author_sort Allen, Christopher J.
collection PubMed
description BACKGROUND: Up to 30% of patients undergoing transcatheter aortic valve implantation (TAVI) experience minimal symptomatic benefit or die within 1 year, indicating an urgent need for enhanced patient selection. Previous analyses of baseline NT‐proBNP (N‐terminal pro‐brain natriuretic peptide) and TAVI outcomes have assumed a linear relationship, yielding conflicting results. We reexamined the relationship between baseline NT‐proBNP and symptomatic improvement after TAVI. METHODS AND RESULTS: Symptom status, clinical and echocardiographic data, and baseline NT‐proBNP were reviewed from 144 consecutive patients undergoing TAVI for severe symptomatic aortic stenosis. The primary end point was change in New York Heart Association functional class at 1 year. There was a nonlinear, inverted‐U relationship between log‐baseline NT‐proBNP and post‐TAVI change in NYHA class (R (2)=0.4559). NT‐proBNP thresholds of <800 and >10 000 ng/L accurately predicted no symptomatic improvement at 1 year (sensitivity 88%, specificity 83%, positive predictive value 72%, negative predictive value 93%). In adjusted analyses, baseline NT‐proBNP outside this “sweet‐spot” range was the only factor independently associated with poor functional outcome (high: NT‐proBNP >10 000 ng/L, odds ratio [OR], 65; 95% CI, 6–664; low: NT‐proBNP <800 ng/L, OR, 73; 95% CI, 7–738). CONCLUSIONS: Baseline NT‐proBNP is a useful prognostic marker to predict poor symptom relief after TAVI and may indicate when intervention is likely to be futile. Both low (<800 ng/L) and very high (>10 000 ng/L) levels are strongly associated with poor functional outcome, suggesting an alternative cause for symptoms in the former scenario and an irrevocably diseased left ventricle in the latter. Further evaluation of this relationship is warranted.
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spelling pubmed-77637932020-12-28 Baseline NT‐proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation Allen, Christopher J. Joseph, Jubin Patterson, Tiffany Hammond‐Haley, Matthew McConkey, Hannah Z. R. Prendergast, Bernard D. Marber, Michael Redwood, Simon R. J Am Heart Assoc Original Research BACKGROUND: Up to 30% of patients undergoing transcatheter aortic valve implantation (TAVI) experience minimal symptomatic benefit or die within 1 year, indicating an urgent need for enhanced patient selection. Previous analyses of baseline NT‐proBNP (N‐terminal pro‐brain natriuretic peptide) and TAVI outcomes have assumed a linear relationship, yielding conflicting results. We reexamined the relationship between baseline NT‐proBNP and symptomatic improvement after TAVI. METHODS AND RESULTS: Symptom status, clinical and echocardiographic data, and baseline NT‐proBNP were reviewed from 144 consecutive patients undergoing TAVI for severe symptomatic aortic stenosis. The primary end point was change in New York Heart Association functional class at 1 year. There was a nonlinear, inverted‐U relationship between log‐baseline NT‐proBNP and post‐TAVI change in NYHA class (R (2)=0.4559). NT‐proBNP thresholds of <800 and >10 000 ng/L accurately predicted no symptomatic improvement at 1 year (sensitivity 88%, specificity 83%, positive predictive value 72%, negative predictive value 93%). In adjusted analyses, baseline NT‐proBNP outside this “sweet‐spot” range was the only factor independently associated with poor functional outcome (high: NT‐proBNP >10 000 ng/L, odds ratio [OR], 65; 95% CI, 6–664; low: NT‐proBNP <800 ng/L, OR, 73; 95% CI, 7–738). CONCLUSIONS: Baseline NT‐proBNP is a useful prognostic marker to predict poor symptom relief after TAVI and may indicate when intervention is likely to be futile. Both low (<800 ng/L) and very high (>10 000 ng/L) levels are strongly associated with poor functional outcome, suggesting an alternative cause for symptoms in the former scenario and an irrevocably diseased left ventricle in the latter. Further evaluation of this relationship is warranted. John Wiley and Sons Inc. 2020-11-26 /pmc/articles/PMC7763793/ /pubmed/33241754 http://dx.doi.org/10.1161/JAHA.120.017574 Text en © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Allen, Christopher J.
Joseph, Jubin
Patterson, Tiffany
Hammond‐Haley, Matthew
McConkey, Hannah Z. R.
Prendergast, Bernard D.
Marber, Michael
Redwood, Simon R.
Baseline NT‐proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation
title Baseline NT‐proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation
title_full Baseline NT‐proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation
title_fullStr Baseline NT‐proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation
title_full_unstemmed Baseline NT‐proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation
title_short Baseline NT‐proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation
title_sort baseline nt‐probnp accurately predicts symptom response to transcatheter aortic valve implantation
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763793/
https://www.ncbi.nlm.nih.gov/pubmed/33241754
http://dx.doi.org/10.1161/JAHA.120.017574
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