経カテーテル大動脈弁留置術を受ける患者におけるN末端プロB型ナトリウム利尿ペプチドの前向きな意味合い

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a recognized marker of myocardial wall stress, but its prognostic role in patients undergoing transcatheter aortic valve implantation (TAVI) remains incompletely defined. This study assessed whether NT-proBNP levels at admission and discharge - interpreted using age-specific guideline thresholds - are associated with long-term clinical outcomes post-TAVI.

We retrospectively analysed 683 consecutive patients who underwent successful TAVI at Magna Graecia University between 2009 and 2023. NT-proBNP was measured at both admission and discharge. Patients were stratified into low or high NT-proBNP groups based on age-adjusted cutoffs. Among 468 patients with paired measurements, four NT-proBNP trajectory groups were identified: Low-Low, Low-High, High-Low, and High-High. The primary endpoint was a composite of all-cause mortality or heart failure (HF) rehospitalization at 2 years. Multivariable Cox models were used to adjust for confounders. At admission, 41.6% of patients had elevated NT-proBNP, associated with worse echocardiographic parameters and more comorbidities. Elevated baseline NT-proBNP predicted a higher risk of the primary outcome (26.1% vs. 13.7%; HR 2.23; 95% CI, 1.51-3.28) and all-cause mortality (21.3% vs. 9.6%; HR 2.40; 95% CI, 1.52-3.79). Among patients with serial values, 34.6% had persistently elevated NT-proBNP, while only 10.7% improved. High-High and Low-High groups showed worse outcomes compared to Low-Low; High-Low patients had comparable risk to Low-Low.

NT-proBNP, interpreted with age-specific thresholds, is a strong independent predictor of adverse outcomes after TAVI. Serial assessment adds prognostic value and may help guide postprocedural management.