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Periprocedural Changes of NT-proBNP Are Associated With Survival After Transcatheter Aortic Valve Implantation.

ABSTRACT: Background Cardiovascular biomarkers constitute promising tools for improved risk stratification and prediction of outcome in patients undergoing transcatheter aortic valve implantation. We examined the association of periprocedural changes of NT-proBNP (N-terminal pro-B-type natriuretic peptide) with survival after transcatheter aortic valve implantation. Methods and Results NT-proBNP levels were measured in 704 patients before transcatheter aortic valve implantation and at discharge. Patients were grouped as responders and nonresponders depending on an NT-proBNP-based ratio (postprocedural NT-proBNP at discharge/preprocedural NT-proBNP). Overall, 376 of 704 patients showed a postprocedural decrease in NT-proBNP levels (NT-proBNP ratio <1). Responders and nonresponders differed significantly regarding median preprocedural (2822 versus 1187 pg/mL, P<0.001) and postprocedural (1258 versus 3009 pg/mL, P<0.001) NT-proBNP levels. Patients in the nonresponder group showed higher prevalence of atrial fibrillation (47.0% versus 39.4%, P=0.042), arterial hypertension (94.2% versus 87.5%, P=0.002), renal impairment (77.4% versus 69.1%, P=0.013), and peripheral artery disease (24.4% versus 14.6%, P=0.001). In contrast, patients in the responder group had higher prevalence of moderately reduced left ventricular ejection fraction (17.3% versus 11.0%, P=0.017), lower calculated aortic valve area (0.7 versus 0.8 cm², P<0.001), and higher mean pressure gradient (41 versus 35 mm Hg, P<0.001). Median follow-up was 22.6 months. Kaplan-Meier analysis showed a highly significant survival benefit for the responder group compared with the nonresponder group (log-rank test, P<0.001). Conclusions A ratio based on periprocedural changes of NT-proBNP is a simple tool for better risk stratification and is associated with survival in patients after transcatheter aortic valve implantation.

SUBMITTER: Seoudy H

PROVIDER: S-EPMC6405592 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Periprocedural Changes of NT-proBNP Are Associated With Survival After Transcatheter Aortic Valve Implantation.

Seoudy Hatim H Frank Johanne J Neu Markus M Güßefeld Nathalie N Klaus Yannic Y Freitag-Wolf Sandra S Lambers Moritz M Lutter Georg G Dempfle Astrid A Rangrez Ashraf Yusuf AY Kuhn Christian C Frey Norbert N Frank Derk D

Journal of the American Heart Association 20190201 3

Background Cardiovascular biomarkers constitute promising tools for improved risk stratification and prediction of outcome in patients undergoing transcatheter aortic valve implantation. We examined the association of periprocedural changes of NT-proBNP (N-terminal pro-B-type natriuretic peptide) with survival after transcatheter aortic valve implantation. Methods and Results NT-proBNP levels were measured in 704 patients before transcatheter aortic valve implantation and at discharge. Patients ...[more]

PMID: 30686097

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Project description:ObjectiveTranscatheter aortic valve implantation (TAVI) procedures are increasing rapidly, but the durability of tissue valve and periprocedural complications are not satisfactory. Immune reaction to the galactose-α-1,3 galactose β-1,4-N-acetylglucosamine (α-Gal) and conventional processing protocols of cardiac xenografts lead to calcification. Next-generation TAVI needs to be made with α-Gal-free xenografts by multiple anticalcification therapies to avoid immune rejection and enhance durability, and three-dimensional (3D) printing technology to improve the procedural safety.MethodsPorcine pericardia were decellularized and immunologically modified with α-galactosidase. The pericardia were treated by space filler, crosslinked with glutaraldehyde in organic solvent, and detoxified. The sheep-specific nitinol (nickel-titanium memory alloy) wire backbone was made from a 3D-printed model for ovine aortic root. After it passed the fitting test, we manufactured a self-expandable stented valve with the porcine pericardia mounted on the customized nitinol wire-based stent. After in vitro circulation using customized silicone aortic root, we performed TAVI in 9 sheep and obtained hemodynamic, radiological, immunohistopathological, and biochemical results.ResultsThe valve functioned well, with excellent stent fitting and good coronary flow under in vitro circulation. Sheep were sequentially scheduled to be humanely killed until 238 days after TAVI. Echocardiography and cardiac catheterization demonstrated good hemodynamic status and function of the aortic valve. The xenografts were well preserved without α-Gal immune reaction or calcification based on the immunological, radiographic, microscopic, and biochemical examinations.ConclusionsWe proved preclinical safety and efficacy for next-generation α-Gal-free TAVI with multiple anticalcification therapies and 3D-printing technology. A future clinical study is warranted based on these promising preclinical results.

Project description:AimsTo evaluate the patient- and procedure-related predictors of transcatheter aortic-valve implantation (TAVI)-associated ischemic brain lesions and to assess the effect of silent cerebral ischemic lesions (SCIL) on neurocognitive function.Methods and resultsWe investigated 113 consecutive patients with severe aortic stenosis who underwent brain magnetic resonance imaging (MRI) within a week following TAVI. To assess periprocedural cerebral ischemic lesions, diffusion-weighted MRI was utilized. We used multivariate linear regression to identify the independent predictors of TAVI-related ischemic lesion volume (ILV) and periprocedural stroke. Neurocognitive evaluation was performed before and following TAVI at 6-month and one-year follow-up. Following TAVI, a total of 944 new cerebral ischemic lesions were detected in 104 patients (92%). The median ILV was 257 μl (interquartile range [IQR]:97.1-718.8μl) with a median lesion number of 6/patient [IQR:2-10]. The majority of ischemic lesions were clinically silent (95%), while 5% of the lesions induced a stroke, which was confirmed by MRI. Predilatation (β = 1.13[95%CI:0.32-1.93], p = 0.01) and the number of valve positioning attempts during implantation (β = 0.28[95%CI:0.06-0.50], p = 0.02) increased the log-transformed total ILV. Predilatation (OR = 12.04[95%CI:1.46-99.07], p = 0.02) and alternative access routes (OR = 7.84[95%CI:1.01-61.07], p = 0.02) were associated with stroke after adjustments for comorbidities and periprocedural factors. The presence of SCILs were not associated with a change in neurocognitive function that remained stable during the one-year follow-up.ConclusionWhile periprocedural ischemic lesions are frequent, most of them are clinically silent and might not impact the patients' neurocognitive function. The number of valve positioning attempts, predilatation, and alternative access routes should be taken into consideration during TAVI to reduce the ILV and risk for stroke.

Dataset Information

Periprocedural Changes of NT-proBNP Are Associated With Survival After Transcatheter Aortic Valve Implantation.

Publications

Periprocedural Changes of NT-proBNP Are Associated With Survival After Transcatheter Aortic Valve Implantation.

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