N-Terminal Pro-B-Type Natriuretic Peptide for Predicting Early Left Ventricular Ejection Fraction Recovery after Transcatheter Aortic Valve Implantation: A Preliminary Report

Abstract

Objective: To examine the relationship between baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and early recovery of the left ventricular ejection fraction (LVEF) after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS).

Methods: This single-center, retrospective, observational study was conducted at Nagasaki University Hospital. We investigated 19 patients with severe AS with a baseline LVEF of less than 50% who underwent TAVI. Early LVEF recovery was defined as an absolute increase of ≥10% in LVEF 3 months after TAVI compared to the baseline. Differences in LVEF between baseline and 3 months after TAVI (ΔLVEF) were evaluated. The primary outcome measure in the present study was the association between baseline NT-proBNP and ΔLVEF. The impact of old myocardial infarction (OMI) was also evaluated.

Results: Nine patients (47%) with early LVEF recovery were identified. Patients with early LVEF recovery had significantly higher baseline aortic valve (AV) peak velocity (4.9 ± 0.7 vs. 4.1 ± 0.7 m/s; p = 0.037) and mean pressure gradient (63.4 ± 20.4 vs. 44.0 ± 15.0 mmHg; p = 0.037) than those without early LVEF recovery. Baseline NT-proBNP levels were significantly and positively correlated with ΔLVEF (r = 0.50, p = 0.029). In addition, there was a significant inverse correlation between baseline NT-proBNP levels and ΔLV end-diastolic diameter (r = –0.55, p = 0.01). Baseline NT-proBNP also showed a numerically inverse correlation with ΔLV end-systolic diameter (r = –0.43, p = 0.06). Notably, a significant relationship between baseline NT-proBNP and ΔLVEF was observed only in patients without OMI and not in those with OMI.

Conclusion: In patients with severe AS and LVEF less than 50%, a higher level of baseline NT-proBNP was associated with an increased likelihood of early LVEF recovery 3 months after TAVI. This finding was observed only in patients without OMI but not in patients with OMI.