Prognostic significance of natriuretic peptides after transcatheter aortic valve replacement: A systematic review and meta-analysis

BackgroundElevated B-type- and NT-pro-beta natriuretic peptide (BNP and NT-pro-BNP) after transcatheter aortic valve replacement (TAVR) may be associated with worse outcomes. ObjectiveWe performed a systematic review and meta-analysis to investigate the association of post-TAVR BNP and NT-pro BNP levels on all-cause mortality and heart failure hospitalization. MethodsSeven retrospective studies (n=4143) were included, with a mean follow-up of 32 months. Lower BNP and NT-pro BNP was defined as BNP <202 pg/mL or NT-pro BNP <1423 pg/mL, or BNP that decreased >40% or NT-pro BNP decreased >30% from baseline, or pre/post-TAVR BNP or NT-pro BNP ratio [&ge;]1. Higher BNP and NT-pro BNP was defined as BNP >202 pg/mL or NT-pro BNP >35,000 pg/mL or BNP decreased [&le;]40% or pre/post-TAVR ratio [&le;]1 or NT-pro BNP decreased [&le;]30% from baseline or pre/post-procedure NT-pro BNP ratio < 1. ResultsThe mean age was 80 {+/-}6 years in the lower group (n=2578) and 81 {+/-}6 years in the higher group (n=1565). Higher BNP and NT-pro BNP persisting after TAVR were associated with a statistically significant increase in all-cause mortality (HR 2.85 [95% CI 2.15-3.78], p<0.00001) and heart failure hospitalization (HR 4.72 [95% CI 2.94-7.57], p<0.00001). A smaller difference between baseline and post-TAVR BNP and NT-pro BNP was associated with a statistically significant increase in all-cause mortality (HR 2.70 [95% CI 1.87-3.92], p<0.00001). Conclusion[boxh]Individuals with higher natriuretic peptide levels after TAVR have higher hazards of all-cause mortality and heart failure hospitalization when compared with patients having lower post-procedural levels. Natriuretic peptides measured post-TAVR improve risk stratification.