Author + information
- Diego López Otero1,
- Diego Iglesias Alvarez2,
- Pablo José Antúnez Muiños3 and
- José Ramón González Juanatey3
To determine if previous admission due to heart failure (HF) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) has a prognostic value in terms of mortality or rehospitalization due to heart failure (rHF) during the first year after TAVI.
Retrospective study involving 349 patients undergoing TAVI. HF was defined according to the ESC guidelines. Pro B-type natriuretic peptide (pro-BNP) was determined in all patients 24 hours before TAVI and 3 months after implantation. Pro-BNP levels were transformed to logarithm to homogenize the sample (log pro-BNP). We analyzed the association between HF and clinical events after TAVI using multivariable logistic regression models.
The mean age of the population was 82.4 ± 5.7 years, 56% women, with a mean logistic EuroScore of 18.39 ± 10.9% and STS score of 5.9 ± 3.8%.The mean pro-BNP before TAVI was 5051 ± 14661 pg/mL (mean log pro-BNP 3.3 ± 0.51) and at 3 months, 2648 ± 8809 pg/mL (mean log pro-BNP at 3 months 3.02 ± 0.52). 56.7% (n=198) of the patients had previous admission for HF and 10% (n=35) of patients had rHF during the first year after TAVI. There was no significant association between the previous HF and rHF during the first year with mortality at follow-up (709 ± 492 days). The results of the multivariate analysis showed that previous HF admission [HR = 4.1; 95% CI, 1.3-13.0; P = 0.016] and high levels of log pro-BNP 3 months after implantation, [HR = 4.4; 95% CI, 1.2-15.4; P = 0.019], were associated with rHF in the first year after TAVI (after adjustment by age, logistic EuroScore, LVEF and log pro-BNP before implantation).
TAVI reduces dramatically the number of heart failure admissions. History HF, previous to TAVI, and rHF, during the first year after TAVI, are not associated with higher mortality rate in the follow-up. Log pro-BNP at three months after TAVI and previous HF admission are independent predictors of rHF during the first year after TAVI.
STRUCTURAL: Valvular Disease: Aortic