Key result
Elevated discharge NT-proBNP is linked to ~3.2-fold higher 2-year death or HF hospitalization after TAVR.
Why the study?
Discharge NT-proBNP is a recognised prognostic marker after TAVR, but its value after SAVR in patients with severe aortic stenosis and preserved ejection fraction remained uncertain, possibly due to differences in perioperative physiology.
Does discharge NT-proBNP predict the 2-year composite of all-cause death or heart failure rehospitalisation after TAVR compared with SAVR in patients with severe aortic stenosis and preserved ejection fraction?
Cohort (n=556)
No
Does discharge NT-proBNP predict the 2-year composite of all-cause death or heart failure rehospitalisation after TAVR compared with SAVR in patients with severe aortic stenosis and preserved ejection fraction?
In patients with severe aortic stenosis and preserved ejection fraction, discharge NT-proBNP >1000 pg/mL predicts 2-year mortality and heart failure rehospitalization after TAVR, whereas 6-month reassessment is needed for risk stratification after SAVR.
Answers are grounded in this paper and cite their sources.
May aid post-TAVR risk stratification but not SAVR; leaves open whether serial NT-proBNP monitoring refines management in aortic stenosis.
BACKGROUND: Discharge N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a recognised prognostic marker after transcatheter aortic valve replacement (TAVR), but its value after surgical aortic valve replacement (SAVR) remains uncertain, possibly reflecting differences in perioperative physiology. AIMS: To compare the prognostic utility of discharge NT-proBNP after TAVR versus SAVR in patients with severe aortic stenosis and preserved ejection fraction, and to examine the association between NT-proBNP reduction and Left Ventricular Mass Index (LVMI) regression. METHODS: This propensity-matched cohort study included 556 patients (TAVR, n=278; SAVR, n=278) with left ventricular ejection fraction ≥50% treated at a single centre (2019–2023). The primary endpoint was a 2-year composite of all-cause death or heart failure rehospitalisation. RESULTS: After matching, baseline characteristics were well balanced. Discharge NT-proBNP >1000 pg/mL predicted lower event-free survival after TAVR (77.3% vs 91.4%; adjusted HR 3.21, 95% CI 1.96 to 5.26, p<0.001) but not after SAVR (83.8% vs 86.7%; adjusted HR 1.18, p=0.50; p for interaction=0.008). Longer aortic cross-clamp time progressively abolished NT-proBNP prognostic value in SAVR. NT-proBNP reduction correlated with LVMI regression regardless of procedure (β=2.2 per 10% ΔNT-proBNP%, p<0.001). A 6-month NT-proBNP ≤1000 pg/mL identified favourable outcomes irrespective of procedure (adjusted HR 0.51, p=0.002). CONCLUSIONS: Discharge NT-proBNP predicts outcomes after TAVR but not SAVR, likely due to cardiopulmonary bypass-induced inflammation. NT-proBNP reduction correlates with LVMI regression irrespective of procedure. Risk stratification may be optimised by discharge measurement after TAVR and 6-month reassessment after SAVR.
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Zheng et al. (2026) conducted a cohort in Severe aortic stenosis with preserved ejection fraction (n=556). Discharge NT-proBNP >1000 pg/mL after TAVR vs SAVR vs. Discharge NT-proBNP ≤1000 pg/mL was evaluated on 2-year composite of all-cause death or heart failure rehospitalisation (reported as event-free survival) (adjusted HR 3.21, 95% CI 1.96 to 5.26, p=<0.001). Discharge NT-proBNP >1000 pg/mL predicted 2-year death or HF rehospitalisation after TAVR, but not after SAVR.
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