The usefulness of N-terminal prohormone brain natriuretic peptide in patients undergoing aortic valve replacement

Several studies have reported that elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with poor outcomes in patients with heart failure or coronary artery disease. Its prognostic utility in patients undergoing aortic valve replacement (AVR) has not been fully described.

To assess the predictive abilities of the NT-proBNP parameter in terms of the occurrence of serious postoperative complications in the early observation period in patients undergoing aortic valve replacement surgery.

A prospective study was conducted on a group of consecutive patients with hemodynamically significant aortic stenosis who underwent aortic valve replacement surgery. One day before surgery a blood sample for the measurement of biomarker levels was collected from each patient. The primary endpoint was any major adverse events including death within 30 days.

The study included 245 patients who underwent aortic valve replacement surgery with or without concomitant procedures on the ascending aorta. The mean age in the study group was 66 ±11 and there were 149 (61%) men. In 160 patients a biological aortic valve prosthesis was implanted, and in 85 a mechanical valve. The composite endpoint occurred in 74 patients. The actual mortality was 3.2% vs. the mortality of 2.9% predicted by the EuroSCORE II model. In multivariate analysis NT-proBNP (p = 0.01), age (p = 0.02) and NYHA class (p = 0.01) remained independent predictors of the composite endpoint. A correlation was found between the level of NT-proBNP and hs-TnT (r = 0.27; p < 0.001), ejection fraction (EF) (r = -0.48; p < 0.001), NYHA class (r = 0.3; p < 0.001) and pulmonary blood pressure (r = 0.48; p < 0.001).

Elevated preoperative NT-proBNP was associated with a poorer outcome following AVR.