E-24 | N-terminal pro-brain natriuretic peptide as a Prognostic Indicator of Mortality and Functional Status in Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

Models to predict patient-specific risk and benefit after TAVR are lacking. Baseline and post-TAVR N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels have been associated with outcomes after TAVR, though study results have been heterogeneous. This is a single-center prospective study of 173 patients with severe AS (AVA<1.0 cm2) undergoing TAVR at a large medical center between January 1, 2020, and January 1, 2022. The primary endpoint was mortality at 1 year. Secondary endpoints were change in quality of life as assessed by change in Kansas City Questionnaire (KCCQ) scores and change in functional status as assessed by change in distance traveled on a 6-minute walk test (6MWD), from baseline to 30-days and 1-year after TAVR. Blood samples for the assessment of NT-pro-BNP levels were obtained at baseline, 30 days and one year after TAVR. Death occurred in 13/173 (7.5%) patients within 1 year of TAVR. The mean age of the cohort was 75.6±12.2 years and 53.8% were male. The baseline NT-pro-BNP was 2051.55 ± 4869.56 pg/mL. Following TAVR, there was a significant reduction of NT-pro-BNP by 712.7 ± 3451.9 pg/mL at 30-days (p=0.041). Pre-TAVR baseline levels of NT-pro-BNP were significantly higher among those who died vs were alive at 1 year (4163.9 ± 6706.4 pg/mL vs. 1873.2 ± 4667.8 pg/mL, p = 0.004). Patients in the highest NT-pro-BNP tertile (NT-pro-BNP 1233-33875 pg/mL at baseline had a higher mortality rate (14.0%) compared to those in the middle (357-1232 pg/mL; 7.4% mortality) and lowest (11.0-356 pg/mL; 1.8% mortality) tertiles (p = 0.021). ΔNT-pro-BNP at 30 days was not associated with 1-yr mortality. TAVR was associated with an improvement in 30-day KCCQ (13.7±20.6). There was no association between baseline NT-pro-BNP and ΔKCCQ or Δ6MWD. Baseline NT-pro-BNP was significantly associated with all-cause 1-year mortality after TAVR, with the highest tertile patients having a 7.5-fold greater mortality than the lowest tertile. Baseline NT-pro-BNP may be a valuable component of a multi-parameter tool to enhance risk stratification and prognostication in patients undergoing TAVR.