Key result
In patients undergoing Venus P-valve implantation, baseline NT-proBNP <70 pg/mL and LVEDP <11 mmHg predicted a higher chance of peak VO2 improvement compared to those without (75% vs 10%, P=0.041).
Why the study?
Prognostic factors remain unclear in patients undergoing transcatheter implantation of Venus P-valve for severe pulmonary regurgitation associated with native right ventricular outflow tract.
Does transcatheter implantation of Venus P-valve improve RV volume and cardiopulmonary exercise capacity in patients with severe pulmonary regurgitation?
Cohort (n=15)
Does transcatheter implantation of Venus P-valve improve RV volume and cardiopulmonary exercise capacity in patients with severe pulmonary regurgitation?
Transcatheter Venus P-valve implantation in severe pulmonary regurgitation reduces RV volume and NT-proBNP, but baseline NT-proBNP and LVEDP may be needed to predict exercise capacity improvement.
Answers are grounded in this paper and cite their sources.
May identify Venus P-valve responders; hypothesis-generating and requires prospective validation before guiding selection.
Prognostic factors remain unclear in patients undergoing transcatheter implantation of Venus P-valve for their severe pulmonary regurgitation associated with native right ventricular (RV) outflow tract. Between January 2017 and October 2018, we prospectively collected data of patient characteristics, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, and levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) before and 6–12 months after valve graft implantation. Fifteen patients (male: 8, median age: 24.8 years) were enrolled. The procedure success rate was 100%. The median follow-up was 16.3 months without any dysfunction of the valve graft. The cohort demonstrated a significant improvement in cardiac index (from 3.3 to 3.9 L/min/m2) and increase of percentage of New York Heart Association functional class I (P < 10−3), reduction in RV end-diastolic volume index (P = 0.008), and reductions in NT-proBNP levels (from 78.9 to 45.8 pg/mL, P = 0.040). However, the peak oxygen consumption (VO2) dropped from 50.2% to 48.5% of the predicted value. Interestingly, we determined that patients with NT-proBNP levels below 70 pg/mL and left ventricular end-diastolic pressure (LVEDP) below 11 mmHg had a significantly higher chance of exhibiting improvement in peak VO2 compared with those without (3/4 vs 1/10, P = 0.041). In the small cohort with severe pulmonary regurgitation, implantation of a Venus P-valve led to promising reductions in RV volume. However, no definite improvement in cardiopulmonary exercise capacity or RV ejection fraction was achieved. Levels of NT-proBNP and LVEDP may be helpful for refining the indications of the Venus P-valve implantation.
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Lin et al. (2020) conducted a cohort in Severe pulmonary regurgitation associated with native right ventricular outflow tract (n=15). Transcatheter implantation of Venus P-valve was evaluated on Improvement in peak VO2 (comparing patients with NT-proBNP <70 pg/mL and LVEDP <11 mmHg vs those without) (p=0.041). In patients undergoing Venus P-valve implantation, baseline NT-proBNP <70 pg/mL and LVEDP <11 mmHg predicted a higher chance of peak VO2 improvement compared to those without (75% vs 10%, P=0.041).
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