Key result
Persistently high natriuretic peptides after TAVI linked to ~99% higher long-term mortality risk.
Why the study?
Although guidelines recommend evaluating signs of valve dysfunction within the first year after TAVI, the prognostic value of baseline natriuretic peptide levels and their trajectories for mortality and LVEF recovery has remained unclear.
Do baseline levels and dynamic changes of BNP and NT-proBNP predict all-cause mortality and left ventricular ejection fraction recovery in patients undergoing transcatheter aortic valve implantation?
Cohort (n=1,373)
Yes
Do baseline levels and dynamic changes of BNP and NT-proBNP predict all-cause mortality and left ventricular ejection fraction recovery in patients undergoing transcatheter aortic valve implantation?
Monitoring baseline and dynamic trajectories of BNP and NT-proBNP after TAVI identifies patients with persistent biomarker elevation who are at significantly higher risk for long-term all-cause mortality and impaired LVEF recovery.
Background Current guidelines recommend evaluating signs suggestive for valve dysfunction within the first year after transcatheter aortic valve implantation (TAVI). However, the prognostic value of natriuretic peptides and their trajectories for mortality and left ventricular functional recovery has remained unclear. Purpose We aimed to evaluate the prognostic impact of baseline levels and dynamic changes of brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) on all-cause mortality and left ventricular ejection fraction (LVEF) recovery following TAVI. Methods We analysed 1,373 patients from three European cohorts. BNP (UK cohort) and NT-proBNP (Swiss and German cohorts) were measured at baseline and during follow-up. Biomarker levels were analysed on a continuous (log-transformed) and a categorical (high vs. low) scale. Long-term mortality was assessed in the Swiss (median follow-up 3.7 years) and UK (median follow-up 5.1 years) cohorts using Cox models. In the German cohort, LVEF changes from 7 days to 1 year were analysed using linear regression. Results On multivariable-adjustment for clinical characteristics, baseline natriuretic peptide levels independently predicted mortality in the Swiss cohort (hazard ratio [HR] per log2 increase 1.22, 95% confidence interval [CI] 1.13–1.31, P < 0.001) and in the UK cohort (HR 1.17, 95% CI 1.02–1.34, P = 0.023). Patients with persistently high levels (high/high vs. low/low) exhibited a significantly increased risk of long-term mortality in both cohorts (Swiss cohort: HR 1.99, 95% CI 1.45–2.74, P < 0.001; UK cohort: HR 2.18, 95% CI 1.14–4.17, P = 0.019; Figure 1 and Figure 2, top). Furthermore, in the German cohort, both baseline levels (β 1.10, 95% CI 0.26–1.94, P = 0.011) and dynamic changes (β 4.41, 95% CI 0.90–7.92, P = 0.015; Figure 2, bottom) were independently associated with impaired LVEF recovery from 7 days to 1 year. Conclusion Monitoring BNP/NT-proBNP dynamics is essential for post-TAVI risk stratification. Persistent biomarker elevation is a powerful predictor of both increased mortality and poor functional recovery, aiding in personalised patient management.
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Wenzl et al. (2026) conducted a cohort in Patients undergoing transcatheter aortic valve implantation (TAVI) (n=1,373). Persistently high natriuretic peptide levels (BNP/NT-proBNP) vs. Persistently low natriuretic peptide levels (low/low) was evaluated on Long-term all-cause mortality and left ventricular ejection fraction (LVEF) recovery (HR 1.99, 95% CI 1.45-2.74, p=<0.001). Persistently high BNP/NT-proBNP after TAVI increased long-term mortality risk vs low levels (Swiss HR 1.99, 95% CI 1.45-2.74, P<0.001; UK HR 2.18, P=0.019) and impaired LVEF recovery.
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