NT-proBNP Level Predicts Who May Benefit From TAVR

A normal or (on the other end) a very high level of NT-proBNP should make us look for a cause other than aortic stenosis. If aortic stenosis is not the culprit of the clinical case, a transcatheter aortic valve replacement (TAVR) will hardly benefit these patients.

Nivel NT-proBNP

These data come from a recently published paper in J Am Heart Assoc that may turn NT-proBNP into a valuable tool for TAVR decision-making.

Values under 800 ng/L (deemed normal) or extremely high above 10,000 ng/L identify patients who will not get symptomatic relief after the procedure.

Nobody doubts how beneficial TAVR is for patients with symptomatic aortic stenosis; however, we should bear in mind that said relief is not for all. Up to 30% of patients still experience similar symptoms or die within a year.

This is too large a percentage not to try to fine-tune patient selection.

Read also: Plaque Volume Over Stenosis Degree.

This study included 144 patients (mean age, 83 years) who underwent TAVR and a baseline NT-proBNP analysis.

NT-proBNP makes a “U” curve, where levels under 800 or above 10,000 ng/L predict futility with an 88% sensitivity and an 83% specificity.

In more than half of the cases where the NT-proBNP level was below 800 and the symptoms were not relieved by TAVR, chronic lung disease could explain the dyspnea.

Read also: Sapien 3 Performs Well in “Jobs” for Which It Is Not Designed.

On the other end, a NT-proBNP level above 10,000 may indicate an irrevocably diseased left ventricle.

This work that arises from a single high-volume site is a hypothesis generator. We must keep searching for indicators for better patient selection.

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Original Title: Baseline NT-proBNP accurately predicts symptom response to transcatheter aortic valve implantation.

Reference: Allen CJ et al. J Am Heart Assoc. 2020;9:e017574.

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