Open heart · 2026
Discharge NT-proBNP predicts 2-year outcomes after TAVR but not after SAVR in preserved ejection fraction: a propensity-matched cohort study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zheng Hua-Jie, Zeng Ling-Ling, Guo Mei, Yan Chao-Jun, Xiao Rui-Han, Tang Xiao-Qing, Cheng Yong-Bo, Wei Ya-Nan, Cheng Wei
Аннотация
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.
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.