Baseline nt-probnp accurately predicts symptom response to transcatheter aortic valve implantation

Christopher J. Allen; Jubin Joseph; Tiffany Patterson; Matthew Hammond-Haley; Hannah Z.R. McConkey; Bernard D. Prendergast; Michael Marber; Simon R. Redwood

doi:10.1161/JAHA.120.017574

Baseline nt-probnp accurately predicts symptom response to transcatheter aortic valve implantation

Christopher J. Allen, Jubin Joseph, Tiffany Patterson, Matthew Hammond-Haley, Hannah Z.R. McConkey, Bernard D. Prendergast, Michael Marber, Simon R. Redwood^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

Abstract

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 NTproBNP (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 (R²=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.

Original language	English
Article number	e017574
Journal	Journal of the American Heart Association
Volume	9
Issue number	23
DOIs	https://doi.org/10.1161/JAHA.120.017574
Publication status	Published - 1 Dec 2020

Keywords

Aortic stenosis
NT-proBNP
Transcutaneous aortic valve implantation
Transfemoral aortic valve implantation

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10.1161/JAHA.120.017574

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@article{4933335a2a13496e918df2536cf3889b,

title = "Baseline nt-probnp accurately predicts symptom response to transcatheter aortic valve implantation",

abstract = "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 NTproBNP (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 (R2=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.",

keywords = "Aortic stenosis, NT-proBNP, Transcutaneous aortic valve implantation, Transfemoral aortic valve implantation",

author = "Allen, {Christopher J.} and Jubin Joseph and Tiffany Patterson and Matthew Hammond-Haley and McConkey, {Hannah Z.R.} and Prendergast, {Bernard D.} and Michael Marber and Redwood, {Simon R.}",

note = "Funding Information: Drs Allen, Joseph, and McConkey are supported by a British Heart Foundation Clinical Research Training Fellowships (FS/18/48/33745, FS/15/52/31587, FS/16/51/32365, respectively). Dr Patterson is supported by a National Institute for Health Research Academic Clinical Lectureship. Professor Redwood has received speaker fees from Edwards Lifesciences and has served as an international advisory board member for Medtronic. Professor Prendergast has received speaker fees from Edwards Lifesciences. The remaining authors have no disclosures to report. Publisher Copyright: {\textcopyright} 2020 The Authors. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2020",

month = dec,

day = "1",

doi = "10.1161/JAHA.120.017574",

language = "English",

volume = "9",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "American Heart Association, Inc.",

number = "23",

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TY - JOUR

T1 - Baseline nt-probnp accurately predicts symptom response to transcatheter aortic valve implantation

AU - Allen, Christopher J.

AU - Joseph, Jubin

AU - Patterson, Tiffany

AU - Hammond-Haley, Matthew

AU - McConkey, Hannah Z.R.

AU - Prendergast, Bernard D.

AU - Marber, Michael

AU - Redwood, Simon R.

N1 - Funding Information: Drs Allen, Joseph, and McConkey are supported by a British Heart Foundation Clinical Research Training Fellowships (FS/18/48/33745, FS/15/52/31587, FS/16/51/32365, respectively). Dr Patterson is supported by a National Institute for Health Research Academic Clinical Lectureship. Professor Redwood has received speaker fees from Edwards Lifesciences and has served as an international advisory board member for Medtronic. Professor Prendergast has received speaker fees from Edwards Lifesciences. The remaining authors have no disclosures to report. Publisher Copyright: © 2020 The Authors. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2020/12/1

Y1 - 2020/12/1

N2 - 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 NTproBNP (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 (R2=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.

AB - 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 NTproBNP (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 (R2=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.

KW - Aortic stenosis

KW - NT-proBNP

KW - Transcutaneous aortic valve implantation

KW - Transfemoral aortic valve implantation

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U2 - 10.1161/JAHA.120.017574

DO - 10.1161/JAHA.120.017574

M3 - Article

C2 - 33241754

AN - SCOPUS:85097004099

SN - 2047-9980

VL - 9

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 23

M1 - e017574

ER -

Baseline nt-probnp accurately predicts symptom response to transcatheter aortic valve implantation

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