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N‐terminal pro‐B‐type natriuretic peptide‐ratio predicts mortality after transcatheter aortic valve replacement

We studied the prognostic value of plasma N‐terminal pro‐brain natriuretic peptide (NT‐proBNP)‐ratio, which is independent of individual cutoff levels, in predicting mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Background: Elevated levels of natriuretic peptides are associated with adverse outcomes across a wide spectrum of cardiovascular diseases. However, cutoff values differ according to age, gender, and body weight. Methods: 244 TAVR patients with preprocedural NT‐proBNP levels were analyzed, and the predictive value of NT‐proBNP‐ratio (measured NT‐proBNP/maximal normal NT‐proBNP values specific for age and gender) on all‐cause‐mortality was assessed in a multivariate model. Results: Median NT‐proBNP‐ratio was 4.2 [IQR 1.8–9.7]. All‐cause mortality at 30 days was 3.4% in patients with less than median NT‐proBNP‐ratio, and 14.0% in patients with more than median NT‐proBNP‐ratio (P = 0.02). All‐cause mortality at 1 year was 8.5% in patients with less than median NT‐proBNP‐ratio, and 32.1% in those with more than median NT‐proBNP‐ratio (P = 0.001). Cumulative survival declined with increasing quartiles of NT‐proBNP‐ratio (log rank P = 0.001). All patients with a NT‐proBNP‐ratio below 1.5 survived at 1‐year follow‐up. In ROC analysis, NT‐proBNP‐ratio significantly predicted 30‐day (AUC = 0.72; P = 0.002) and 1‐year all‐cause mortality (AUC = 0.72; P < 0.001). By multivariate Cox regression analysis, NT‐proBNP‐ratio, chronic obstructive pulmonary disease, and serum creatinine were the only independent predictors of all‐cause mortality. Conclusions: Elevated NT‐proBNP‐ratio was associated with increased short‐ and long‐term mortality after TAVR, and independently predicted all‐cause mortality. NT‐proBNP‐ratio should be considered in the risk stratification of patients undergoing TAVR. © 2015 Wiley Periodicals, Inc.