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

Introduction: 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. Aim: 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. Material and methods: 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. Results: 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). Conclusions: Elevated preoperative NT-proBNP was associated with a poorer outcome following AVR. [ABSTRACT FROM AUTHOR]