Temporal changes in BNP levels and their prognostic impact on future cardiac events in patients undergoing transcatheter aortic valve implantation

BACKGROUND Detailed patterns of changes in brain natriuretic peptide (BNP) levels during the perioperative period and long-term follow-up after transcatheter aortic valve implantation (TAVI) and the prognostic significance of these BNP levels have not been fully elucidated. METHODS This was a single-center observational study. Among 464 patients who underwent TAVI, 408 who survived to discharge and whose baseline and postoperative (2 days after TAVI) BNP levels were available were included. The primary endpoint was the occurrence of a composite of cardiac death and heart failure hospitalization after discharge during follow-up. RESULTS Among the 408 patients (83.4 ± 4.9 years, 35.3% male), the BNP levels were 157(79-375) pg/mL at baseline and 142(74-281) pg/mL at 2-days after TAVI, and significantly decreased (p < 0.001). After discharge, BNP levels were 84(48-178) at 1-month, 70(42-140) at 6-months, and 65(36-135) at 1-year, decreased over time (p < 0.001). During a median follow-up of 2.0 years (1.0-3.1 years), the primary endpoint was observed in 33 patients. Patients with the primary endpoint had significantly higher BNP levels at baseline and 2-days after TAVI than those without. Postoperative BNP (2-days after TAVI) more accurately predicted the incidence of primary endpoint than baseline BNP [c-statistic 0.75(0.67-0.83) vs. 0.64(0.54-0.74); the difference p = 0.03]. CONCLUSIONS BNP levels decreased immediately after TAVI compared with baseline and continued to decline gradually for up to 1 year. Both pre- and postoperative BNP levels were associated with subsequent cardiac events after TAVI, and postoperative BNP levels more accurately predicted cardiac events after discharge.