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Prognostic value of NT pro-BNP levels on mild to long term outcome after TAVI: a monocentric study
65
Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
063
The authors hereby declare no conflict of interest
Mitral regurgitation etiology affects outcomes in high risk or inoperable patients undergoing transcatheter aortic valve implantation for severe aortic stenosis
235 Prognostic value of NT pro-BNP levels on mild to long term outcome after TAVI: a monocentric study G. Gouffran* (1)(2), D. Blanchard (2), S. Chassaing (2), O. Bar (2), C. Barbey (2), MA. Arnould (2), O. Lepage (3), D. Chatel (3) (1) GHI Le Raincy-Montfermeil, Cardiologie, Montfermeil, France – (2) Clinique Saint-Gatien, Cardiologie interventionnelle, Tours, France – (3) Clinique Saint-Gatien, Chirurgie cardiaque, Tours, France *Corresponding author: [email protected] Introduction Individual risk of transcatheter aortic valve implantation (TAVI) on mild to long term outcome remains difficult to assess. We aimed to investigate the prognostic value of NT pro-BNP in patients treated by TAVI with trans-femoral access (TFA) and surviving at 30 days. We also focused on the utility of analyzing variation of NT pro-BNP. Methods Three hundred and fifteen patients with symptomatic aortic stenosis treated by TAVI with TFA and surviving at 30 days were retrospectively included between 2009 and 2014 in our center. We used Medtronic CoreValve system, Edwards SAPIEN or SAPIEN XT valve. Clinical, biological and echographic data were collected. NT pro-BNP was measured serially before, after and 1 month after TAVI. Patients were female in 52% of cases, with a mean age of 84±5 years. Mean Euroscore was 18.9±9.8%, LVEF was 54.3±13% and mean aortic valve area 0.6±0,15cm 2. Mean follow-up was 578±437 days. NT pro-BNP was analyzed as continuous and discrete variables using tercile of all measurement. Results While pre or immediately post procedure NT pro-BNP was not associated with increase mortality, patients with high NT pro-BNP at 1 month after TAVI (higher tercile > 3181 pg/mL) had increased risk of mortality (p<0.001); increase risk of mortality was particularly driven by cardiovascular mortality (p<0.02). Male gender, renal failure, altered LVEF, mean aortic valve gradient, aortic regurgitation, post-procedural mitral regurgitation or pulmonary hypertension were significantly associated with the higher tercile of NT pro-BNP at 1 month. Moreover, worsening of NT pro-BNP levels (upgrading for one tercile) after or at 1 month after TAVI was associated with unfavorable outcome (respectively p=0.016 and p<0.001).
E. Ouzan* (1), B. Kindya (2), E. Gonen (1), S. Lerakis (2), I. Gotsman (1), V. Thourani (2), E. Karayel (1), B. Leshnower (2), R. Beeri (1), P. Block (2), D. Gilon (1), R. Guyton (2), H. Danenberg (1), V. Babaliaros (2), C. Lotan (1), K. Mavromatis (2) (1) Hadassah Hebrew University Medical Center, Heart Institute, Jerusalem, Israël – (2) Emory University Hospital, Heart Institute, Atlanta, Etats-Unis *Corresponding author: [email protected] Background Many patients undergoing transcatheter aortic valve i implantation (TAVI) for severe aortic stenosis (AS) have mitral regurgitation (MR). Prior work has suggested that MR affects echocardiographic and clinical outcomes. Methods High risk or inoperable patients who underwent balloon or selfexpanding TAVI for AS at two institutions had echocardiography at baseline and 30 days and were followed for mid-term clinical outcomes. MR was graded as functional or organic and mild, moderate, or severe. Results 251 of 257 patients that underwent TAVI from 2007-13 had MR, 53% of which was functional. Functional MR patients were more likely male, but otherwise had similar baseline characteristics and 30-day echo outcomes compared to organic MR patients. Functional MR patients had a significantly higher probability of survival free of death or CHF than organic MR patients (p=0.03, Figure 1). Multivariable analysis showed functional MR (HR=0.49, p=0.002), a balloon expandable valve (HR=0.16, p<0.001), and larger change in AV gradient (HR=0.92, p=0.01) were protective against death or CHF. Subgroup analysis of mod-severe MR showed a significant decrease in 30-day pulmonary artery systolic pressure in the functional MR group compared to organic MR (5.9 vs. 3.4 mmHg, p=0.03). Conclusions TAVI patients with functional MR had better outcomes than organic MR patients. An evaluation of MR etiology should occur during pre-procedural planning and inform decision making.
Conclusion High NT pro-BNP at one month after TAVI (constant or secondary worsening) is associated with higher mortality at mild to long term.
Abstract 063 – Figure
The authors hereby declare no conflict of interest
Abstract 235 – Figure The authors hereby declare no conflict of interest
© Elsevier Masson SAS. All rights reserved.
Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
063
The authors hereby declare no conflict of interest
Mitral regurgitation etiology affects outcomes in high risk or inoperable patients undergoing transcatheter aortic valve implantation for severe aortic stenosis
235 Prognostic value of NT pro-BNP levels on mild to long term outcome after TAVI: a monocentric study G. Gouffran* (1)(2), D. Blanchard (2), S. Chassaing (2), O. Bar (2), C. Barbey (2), MA. Arnould (2), O. Lepage (3), D. Chatel (3) (1) GHI Le Raincy-Montfermeil, Cardiologie, Montfermeil, France – (2) Clinique Saint-Gatien, Cardiologie interventionnelle, Tours, France – (3) Clinique Saint-Gatien, Chirurgie cardiaque, Tours, France *Corresponding author: [email protected] Introduction Individual risk of transcatheter aortic valve implantation (TAVI) on mild to long term outcome remains difficult to assess. We aimed to investigate the prognostic value of NT pro-BNP in patients treated by TAVI with trans-femoral access (TFA) and surviving at 30 days. We also focused on the utility of analyzing variation of NT pro-BNP. Methods Three hundred and fifteen patients with symptomatic aortic stenosis treated by TAVI with TFA and surviving at 30 days were retrospectively included between 2009 and 2014 in our center. We used Medtronic CoreValve system, Edwards SAPIEN or SAPIEN XT valve. Clinical, biological and echographic data were collected. NT pro-BNP was measured serially before, after and 1 month after TAVI. Patients were female in 52% of cases, with a mean age of 84±5 years. Mean Euroscore was 18.9±9.8%, LVEF was 54.3±13% and mean aortic valve area 0.6±0,15cm 2. Mean follow-up was 578±437 days. NT pro-BNP was analyzed as continuous and discrete variables using tercile of all measurement. Results While pre or immediately post procedure NT pro-BNP was not associated with increase mortality, patients with high NT pro-BNP at 1 month after TAVI (higher tercile > 3181 pg/mL) had increased risk of mortality (p<0.001); increase risk of mortality was particularly driven by cardiovascular mortality (p<0.02). Male gender, renal failure, altered LVEF, mean aortic valve gradient, aortic regurgitation, post-procedural mitral regurgitation or pulmonary hypertension were significantly associated with the higher tercile of NT pro-BNP at 1 month. Moreover, worsening of NT pro-BNP levels (upgrading for one tercile) after or at 1 month after TAVI was associated with unfavorable outcome (respectively p=0.016 and p<0.001).
E. Ouzan* (1), B. Kindya (2), E. Gonen (1), S. Lerakis (2), I. Gotsman (1), V. Thourani (2), E. Karayel (1), B. Leshnower (2), R. Beeri (1), P. Block (2), D. Gilon (1), R. Guyton (2), H. Danenberg (1), V. Babaliaros (2), C. Lotan (1), K. Mavromatis (2) (1) Hadassah Hebrew University Medical Center, Heart Institute, Jerusalem, Israël – (2) Emory University Hospital, Heart Institute, Atlanta, Etats-Unis *Corresponding author: [email protected] Background Many patients undergoing transcatheter aortic valve i implantation (TAVI) for severe aortic stenosis (AS) have mitral regurgitation (MR). Prior work has suggested that MR affects echocardiographic and clinical outcomes. Methods High risk or inoperable patients who underwent balloon or selfexpanding TAVI for AS at two institutions had echocardiography at baseline and 30 days and were followed for mid-term clinical outcomes. MR was graded as functional or organic and mild, moderate, or severe. Results 251 of 257 patients that underwent TAVI from 2007-13 had MR, 53% of which was functional. Functional MR patients were more likely male, but otherwise had similar baseline characteristics and 30-day echo outcomes compared to organic MR patients. Functional MR patients had a significantly higher probability of survival free of death or CHF than organic MR patients (p=0.03, Figure 1). Multivariable analysis showed functional MR (HR=0.49, p=0.002), a balloon expandable valve (HR=0.16, p<0.001), and larger change in AV gradient (HR=0.92, p=0.01) were protective against death or CHF. Subgroup analysis of mod-severe MR showed a significant decrease in 30-day pulmonary artery systolic pressure in the functional MR group compared to organic MR (5.9 vs. 3.4 mmHg, p=0.03). Conclusions TAVI patients with functional MR had better outcomes than organic MR patients. An evaluation of MR etiology should occur during pre-procedural planning and inform decision making.
Conclusion High NT pro-BNP at one month after TAVI (constant or secondary worsening) is associated with higher mortality at mild to long term.
Abstract 063 – Figure
The authors hereby declare no conflict of interest
Abstract 235 – Figure The authors hereby declare no conflict of interest
© Elsevier Masson SAS. All rights reserved.