Long-Term Prognostic Value and Serial Changes of Plasma N-Terminal Prohormone B-Type Natriuretic Peptide in Patients Undergoing Transcatheter Aortic Valve Implantation Henrique B. Ribeiro, MD, Marina Urena, MD, Florent Le Ven, MD, Luis Nombela-Franco, MD, Ricardo Allende, MD, Marie-Annick Clavel, DVM, PhD, Abdellaziz Dahou, MD, Mélanie Côté, MSc, Jerôme Laflamme, MS, Louis Laflamme, MS, Hugo DeLarochellière, MS, Robert DeLarochellière, MD, Daniel Doyle, MD, Éric Dumont, MD, Sebastien Bergeron, MD, Philippe Pibarot, DVM, PhD, and Josep Rodés-Cabau, MD* Little is known about the usefulness of evaluating cardiac neurohormones in patients un- dergoing transcatheter aortic valve implantation (TAVI). The objectives of this study were to evaluate the baseline values and serial changes of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) after TAVI, its related factors, and prognostic value. A total of 333 consecutive patients were included, and baseline, procedural, and follow-up (median 20 months, interquartile range 9 to 36) data were prospectively collected. Sys- tematic NT-proBNP measurements were performed at baseline, hospital discharge, 1, 6, and 12 months, and yearly thereafter. Baseline NT-proBNP values were elevated in 86% of the patients (median 1,692 pg/ml); lower left ventricular ejection fraction and stroke volume index, greater left ventricular mass, and renal dysfunction were associated with greater baseline values (p <0.01 for all). Higher NT-proBNP levels were independently associated with increased long-term overall and cardiovascular mortalities (p <0.001 for both), with a baseline cut-off level of w2,000 pg/ml best predicting worse outcomes (p <0.001). At 6- to 12-month follow-up, NT-proBNP levels had decreased (p <0.001) by 23% and remained stable up to 4-year follow-up. In 39% of the patients, however, there was a lack of NT-proBNP improvement, mainly related to preprocedural chronic atrial fibrillation, lower mean transaortic gradient, and moderate-to-severe mitral regurgitation (p <0.01 for all). In conclusion, most patients undergoing TAVI presented high NT-proBNP levels, and a lack of improvement was observed in >1/3 of the patients after TAVI. Also, higher NT-proBNP levels predicted greater overall and cardiac mortalities at a median follow-up of 2 years. These findings support the implementation of NT-proBNP measurements for the clinical decision-making process and follow-up of patients undergoing TAVI. Ó 2014 Elsevier Inc. All rights reserved. (Am J Cardiol 2014;113:851e859) Natriuretic peptides (NPs) are elevated in a number of cardiovascular diseases such as cardiac hypertrophy, acute coronary syndromes, and heart failure. 1e3 In the context of aortic stenosis (AS), both B-type natriuretic peptide (BNP) and its prohormone—N-terminal prohormone B-type natri- uretic peptide (NT-proBNP)—levels are also elevated, and the degree of their increase has been correlated with the severity of AS, symptom status, and clinical outcomes after surgical aortic valve replacement (SAVR). 2,4 In the context of transcatheter aortic valve implantation (TAVI), some studies have suggested an association between NP levels and early and 1-year outcomes after TAVI. However, most of these studies included a limited number of patients, relatively short follow-up periods (1 year), and very few data on cardiovascular outcomes (i.e., cardiac death, heart failure). 5e10 More importantly, although a significant decrease in NP levels has been shown after TAVI, the de- gree of these changes and the factors associated with the lack of cardiac neurohormonal improvement have not yet been evaluated. The aim of this study was therefore to evaluate the serial changes, related factors, and the prog- nostic significance of NT-proBNP on the long-term follow- up of a large cohort of patients undergoing TAVI. Methods A total of 333 consecutive patients with symptomatic AS considered as not suitable or at very high risk for SAVR underwent a TAVI procedure and were included in the study. Details about the TAVI procedure have been pro- vided elsewhere. 11 All baseline and procedural characteris- tics were prospectively collected on preset data collection forms. Baseline co-morbidities were defined according to the Society of Thoracic Surgeons criteria, and Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Manuscript received August 16, 2013; revised manuscript received and accepted November 12, 2013. This study was funded, in part, by research Grants MOP-57745 and MOP-126072 from the Canadian Institutes of Health Research (CIHR), Canada. See page 858 for disclosure information. *Corresponding author: Tel: (418) 656-8711; fax: (418) 656-4544. E-mail address: josep.rodes@criucpq.ulaval.ca (J. Rodés-Cabau). 0002-9149/14/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. www.ajconline.org http://dx.doi.org/10.1016/j.amjcard.2013.11.038