Key result
Higher left atrial volume index independently predicted a lower likelihood of decreased B-type natriuretic peptide levels 1 year after transcatheter aortic valve replacement (OR 0.55 per 10mL/m2 increase).
Why the study?
Poor BNP improvement after TAVR is associated with increased morbidity and mortality, but clinical parameters related to changes in BNP levels after TAVR are poorly understood.
Does baseline left atrial volume index (LAVI) predict the improvement of B-type natriuretic peptide (BNP) levels 1 year after transfemoral transcatheter aortic valve replacement in patients with severe aortic stenosis?
Observational (n=127)
No
Does baseline left atrial volume index (LAVI) predict the improvement of B-type natriuretic peptide (BNP) levels 1 year after transfemoral transcatheter aortic valve replacement in patients with severe aortic stenosis?
Odds Ratio: 0.55 (95% CI 0.38–0.77)
p-value: p=<0.01
In patients undergoing TF-TAVR for severe aortic stenosis, a larger baseline left atrial volume index independently predicts a lack of BNP improvement at 1 year, suggesting its utility for pre-procedural risk stratification.
Larger baseline LAVI was associated with less BNP improvement after TAVR; hypothesis-generating and requires prospective validation before guiding risk stratification.
Background: In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Furthermore, poor BNP improvement is associated with increased morbidity and mortality. However, little is known about the clinical parameters related to the change in BNP levels after TAVR procedure. Methods and Results: This study population consisted of 127 consecutive patients of symptomatic severe AS with preserved ejection fraction (EF) who underwent TF-TAVR. The median BNP level was significantly decreased from 252.5 pg/ml to 146.8 pg/ml in all 127 patients 1 year after TF-TAVR (P<0.01). However, the patients could be divided into 2 groups according to decrease (72%) or increase (28%) in plasma BNP level. Multivariate logistic regression analysis revealed that AV peak velocity, pre-procedural BNP, and larger left atrial volume index (LAVI) were found to be an independent predictor of increased BNP level 1 year after TAVR (OR 0.55, 95% CI 0.38-0.77; p<0.01). LAVI were negatively correlated with the change in BNP level before and 1 year after TAVR (r=0.47, P<0.01). The ROC analysis demonstrated that 52.9ml/m 2 was the optimal cut-off value of LAVI for decreasing BNP 1 year after TAVR (area under the curve 0.69) with 64% sensitivity and 70% specificity. Conclusions: In addition to AV peak velocity and pre-procedural BNP, LAVI independently predicts future improvement of BNP levels 1 year after TAVR. Our findings indicate an additive predictive value of assessment of LAVI before TAVR procedure for risk stratification.
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Ito et al. (2021) conducted an observational in Symptomatic severe aortic stenosis (n=127). Left atrial volume index (LAVI) vs. Lower LAVI was evaluated on Decreased BNP level 1 year after TAVR (OR 0.55, 95% CI 0.38-0.77, p=<0.01). Higher left atrial volume index independently predicted a lower likelihood of decreased B-type natriuretic peptide levels 1 year after transcatheter aortic valve replacement (OR 0.55 per 10mL/m2 increase).
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