Persistently elevated natriuretic peptides (high/high trajectory) after TAVI predicted higher long-term all-cause mortality compared to low/low trajectories (adj HR 1.91; 95% CI 1.38-2.64; P<0.001).
Cohort (n=2,783)
Yes
Do longitudinal trajectories of natriuretic peptides predict long-term all-cause mortality in patients undergoing TAVI?
Serial assessment of natriuretic peptides before and after TAVI enhances risk stratification, as persistently elevated levels strongly predict long-term mortality.
Effect estimate: adj HR 1.91 (95% CI 1.38-2.64)
p-value: p=< 0.001
Abstract Background Identification of high-risk individuals after transcatheter aortic valve implantation (TAVI) is essential for personalized care. Circulating brain natriuretic peptide (BNP) or N-terminal pro–B-type natriuretic peptide (NT-proBNP) reflect myocardial stress, yet the prognostic implication of their longitudinal trajectories have not been fully characterized. Purpose We aimed to evaluate the association between BNP or NT-proBNP dynamics with long-term all-cause mortality following TAVI in two independent large cohorts. Methods Patients undergoing TAVI at a high-volume university centre in the United Kingdom (UK; n = 990) were recruited into this prospective cohort study. Patient characteristics along with pre- and post-procedural imaging results and BNP levels before the procedure and at 3-12 months after the procedure were recorded. An independent cohort of 1,793 patients undergoing TAVI at a high-volume university hospital in Switzerland between January 2008 and May 2024 was also included, with a median follow-up of 4.0 years (IQR 2.2–5.6). In this cohort, N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured at baseline and at 2 weeks after the procedure. Patients were categorized according to natriuretic peptide trajectories (low/low, high/low, low/high, high/high). Long-term all-cause mortality was assessed using Kaplan–Meier estimates and multivariable-adjusted Cox regression. Results During median follow-up of 5.3 years (UK) and 4.0 years (Switzerland), 414 (41.8%) and 796 (44.4%) all-cause deaths occurred, respectively. In the UK cohort, longitudinal changes in BNP using a threshold of 400 pg/mL were independently associated with long-term mortality (high/low vs. low/low: adjusted hazard ratio adj HR 1.25, 95% CI 0.75–2.09, P = 0.397; high/high vs. low/low: adj HR 1.91, 95% CI 1.05–3.46, P = 0.033). Similarly, in the Swiss cohort, early post-procedural changes in NT-proBNP using a threshold of 1800 pg/mL predicted higher long-term mortality (high/low vs. low/low: adj HR 1.23, 95% CI 0.80–1.90, P = 0.336; high/high vs. low/low: adj HR 1.91, 95% CI 1.38–2.64, P 0.001). Cumulative incidence curves demonstrated significant differences in mortality across trajectory groups in both cohorts. Conclusion Natriuretic peptide trajectories independently predicted long-term mortality after TAVI. Patients with persistently elevated BNP or NT-proBNP are at particularly high mortality risk. Serial assessment may enhance post-TAVI risk stratification and guide personalized management.Cumulative incidence of mortalityFor image description, please refer to the figure legend and surrounding text.
Wenzl et al. (Sun,) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=2,783). Natriuretic peptide trajectories (BNP or NT-proBNP) vs. Low/low trajectory was evaluated on Long-term all-cause mortality (adj HR 1.91, 95% CI 1.38-2.64, p=< 0.001). Persistently elevated natriuretic peptides (high/high trajectory) after TAVI predicted higher long-term all-cause mortality compared to low/low trajectories (adj HR 1.91; 95% CI 1.38-2.64; P<0.001).