# Prognostic implications of N-terminal pro–B-type natriuretic peptide in patients undergoing transcatheter aortic valve implantation

## TL;DR

This study shows that N-terminal pro–B-type natriuretic peptide levels are strong predictors of poor outcomes in patients after a heart valve procedure called TAVI.

## Contribution

The study introduces age-specific thresholds for NT-proBNP to assess long-term outcomes after TAVI and highlights the value of serial measurements.

## Key findings

- Elevated baseline NT-proBNP predicted higher risk of mortality and heart failure rehospitalization after TAVI.
- Patients with persistently high NT-proBNP levels had the worst outcomes compared to those with low levels.
- Serial NT-proBNP measurements added prognostic value and could guide post-TAVI management.

## Abstract

N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a recognized marker of myocardial wall stress, but its prognostic role in patients undergoing transcatheter aortic valve implantation (TAVI) remains incompletely defined. This study assessed whether NT-proBNP levels at admission and discharge – interpreted using age-specific guideline thresholds – are associated with long-term clinical outcomes post-TAVI.

We retrospectively analysed 683 consecutive patients who underwent successful TAVI at Magna Graecia University between 2009 and 2023. NT-proBNP was measured at both admission and discharge. Patients were stratified into low or high NT-proBNP groups based on age-adjusted cutoffs. Among 468 patients with paired measurements, four NT-proBNP trajectory groups were identified: Low–Low, Low–High, High–Low, and High–High. The primary endpoint was a composite of all-cause mortality or heart failure (HF) rehospitalization at 2 years. Multivariable Cox models were used to adjust for confounders. At admission, 41.6% of patients had elevated NT-proBNP, associated with worse echocardiographic parameters and more comorbidities. Elevated baseline NT-proBNP predicted a higher risk of the primary outcome (26.1% vs. 13.7%; HR 2.23; 95% CI, 1.51–3.28) and all-cause mortality (21.3% vs. 9.6%; HR 2.40; 95% CI, 1.52–3.79). Among patients with serial values, 34.6% had persistently elevated NT-proBNP, while only 10.7% improved. High–High and Low–High groups showed worse outcomes compared to Low–Low; High–Low patients had comparable risk to Low–Low.

NT-proBNP, interpreted with age-specific thresholds, is a strong independent predictor of adverse outcomes after TAVI. Serial assessment adds prognostic value and may help guide postprocedural management.