This preprint is under consideration at The International Journal of Cardiovascular Imaging. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Background: In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Furthermore, poor BNP improvement is associated with increased morbidity and mortality. However, little is known about the clinical parameters related to the change in BNP levels after TAVR procedure.
Methods and Results: This study population consisted of 127 consecutive patients of symptomatic severe AS with preserved ejection fraction (EF) who underwent TF-TAVR. The median BNP level was significantly decreased from 252.5 pg/ml to 146.8 pg/ml in all 127 patients 1 year after TF-TAVR (P<0.01). However, the patients could be divided into 2 groups according to decrease (72%) or increase (28%) in plasma BNP level. Multivariate logistic regression analysis revealed that AV peak velocity, pre-procedural BNP, and larger left atrial volume index (LAVI) were found to be an independent predictor of increased BNP level 1 year after TAVR (OR 0.55, 95% CI 0.38-0.77; p<0.01). LAVI were negatively correlated with the change in BNP level before and 1 year after TAVR (r=0.47, P<0.01). The ROC analysis demonstrated that 52.9ml/m2 was the optimal cut-off value of LAVI for decreasing BNP 1 year after TAVR (area under the curve 0.69) with 64% sensitivity and 70% specificity.
Conclusions: In addition to AV peak velocity and pre-procedural BNP, LAVI independently predicts future improvement of BNP levels 1 year after TAVR. Our findings indicate an additive predictive value of assessment of LAVI before TAVR procedure for risk stratification.
Keywords
aortic stenosis, transcatheter aortic valve replacement, left atrium, B-type natriuretic peptide
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CURRENT STATUS: Under Revision
Version 1
Posted 03 Nov, 2021
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Editor invited
On 24 Nov, 2021
Reviews received
Received 07 Nov, 2021
Reviewers invited
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On 01 Nov, 2021
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Editorial decision: Major revisions
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This preprint is under consideration at The International Journal of Cardiovascular Imaging. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 03 Nov, 2021
No community comments so far
Editor invited
On 24 Nov, 2021
Reviews received
Received 07 Nov, 2021
Reviewers invited
Invitations sent on 01 Nov, 2021
Editor assigned
On 01 Nov, 2021
First submitted
On 30 Oct, 2021
Editorial decision: Major revisions
On 24 Oct, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Furthermore, poor BNP improvement is associated with increased morbidity and mortality. However, little is known about the clinical parameters related to the change in BNP levels after TAVR procedure.
Methods and Results: This study population consisted of 127 consecutive patients of symptomatic severe AS with preserved ejection fraction (EF) who underwent TF-TAVR. The median BNP level was significantly decreased from 252.5 pg/ml to 146.8 pg/ml in all 127 patients 1 year after TF-TAVR (P<0.01). However, the patients could be divided into 2 groups according to decrease (72%) or increase (28%) in plasma BNP level. Multivariate logistic regression analysis revealed that AV peak velocity, pre-procedural BNP, and larger left atrial volume index (LAVI) were found to be an independent predictor of increased BNP level 1 year after TAVR (OR 0.55, 95% CI 0.38-0.77; p<0.01). LAVI were negatively correlated with the change in BNP level before and 1 year after TAVR (r=0.47, P<0.01). The ROC analysis demonstrated that 52.9ml/m2 was the optimal cut-off value of LAVI for decreasing BNP 1 year after TAVR (area under the curve 0.69) with 64% sensitivity and 70% specificity.
Conclusions: In addition to AV peak velocity and pre-procedural BNP, LAVI independently predicts future improvement of BNP levels 1 year after TAVR. Our findings indicate an additive predictive value of assessment of LAVI before TAVR procedure for risk stratification.
Figure 1
Figure 2
Figure 3
Figure 4
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