The interaction of forced expiratory volume in 1 s and N-terminal pro-B-type natriuretic peptide with outcomes after transcatheter aortic valve replacement. (16th January 2023)

• Record Type: Journal Article
• Authors: Crestanello, Juan A; Greason, Kevin L; Mathew, Jessey; Eleid, Mackram F; Nkomo, Vuyisile T; Rihal, Charanjit S; Bagameri, Gabor; Holmes, David R; Pislaru, Sorin V; Sandhu, Gurpreet S; Lee, Alexander T; King, Katherine S; Alkhouli, Mohamad
• Is Part Of: European journal of cardio-thoracic surgery. Volume 63:Number 4(2023)
• Publication Date: 2023-01-16
• Subjects: Transcatheter aortic valve replacement -- Lung disease -- Forced expiratory volume in 1 s -- N-terminal pro-B-type natriuretic peptide -- Outcomes; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezad017
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Low forced expiratory volume in 1 s (FEV1) and elevated N-terminal pro-B-type natriuretic peptide (NT-Pro-BNP) have been individually associated with poor outcomes after transcatheter aortic valve replacement (TAVR). We hypothesized a combination of the 2 would provide prognostic indication after TAVR. METHODS: We categorized 871 patients who received TAVR from 2008 to 2018 into 4 groups according to baseline FEV1 (<60% or ≥60% predicted) and NT-Pro-BNP (<1601 or ≥1601 pg/ml): group A ( n = 312, high FEV1, low NT-Pro-BNP), group B ( n = 275, high FEV1, high NT-Pro-BNP), group C ( n = 123 low FEV1, low NT-Pro-BNP) and group D ( n = 161, low FEV1, high NT-Pro-BNP). The primary end point was survival at 1 and 5 years. RESULTS: Patients in group A had more severe aortic stenosis and achieved the best long-term survival at 1 [93% (95% CI: 90–96)] and 5 [45.3% (95% CI: 35.4–58)] years. Low FEV1 and high NT-Pro-BNP (group D) patients had more severe symptoms, higher Society of Thoracic Surgeons predicted risk of operative mortality, lower ejection fraction and aortic valve gradient at baseline. Patients in group D had the worst survival at 1 [76% (95% CI: 69–83)] and 5 years [13.1% (95% CI: 7–25)], hazard ratio compared to group A: 2.29 (95% CI: 1.6–3.2, P < 0.001) with 25.7% of patients in New York Heart Association class III–IV. Patients in groups B and C had intermediate outcomes. CONCLUSIONS: The combination of FEV1 and NT-Pro-BNP stratifies patients into 4 groups with distinct risk profiles and clinical outcomes. Patients with low FEV1 and high NT-Pro-BNP have increased comorbidities, poor functional outcomes and decreased long-term survival after TAVR. Abstract : Chronic lung disease (CLD) is common in patients treated with transcatheter aortic valve replacement (TAVR).