Left Atrial Volume Index Predicts Future Improvement of B-Type Natriuretic Peptide Levels After Transcatheter Aortic Valve Replacement

Abstract Background: In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Furthermore, poor BNP improvement is associated with increased morbidity and mortality. However, little is known about the clinical parameters related to the change in BNP levels after TAVR procedure.Methods and Results: This study population consisted of 127 consecutive patients of symptomatic severe AS with preserved ejection fraction (EF) who underwent TF-TAVR. The median BNP level was significantly decreased from 252.5 pg/ml to 146.8 pg/ml in all 127 patients 1 year after TF-TAVR (P<0.01). However, the patients could be divided into 2 groups according to decrease (72%) or increase (28%) in plasma BNP level. Multivariate logistic regression analysis revealed that AV peak velocity, pre-procedural BNP, and larger left atrial volume index (LAVI) were found to be an independent predictor of increased BNP level 1 year after TAVR (OR 0.55, 95% CI 0.38-0.77; p<0.01). LAVI were negatively correlated with the change in BNP level before and 1 year after TAVR (r=0.47, P<0.01). The ROC analysis demonstrated that 52.9ml/m2 was the optimal cut-off value of LAVI for decreasing BNP 1 year after TAVR (area under the curve 0.69) with 64% sensitivity and 70% specificity.Conclusions: In addition to AV peak velocity and pre-procedural BNP, LAVI independently predicts future improvement of BNP levels 1 year after TAVR. Our findings indicate an additive predictive value of assessment of LAVI before TAVR procedure for risk stratification.

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Higher preoperative left atrial volume index predicts lack of mitral regurgitation improvement after transcatheter aortic valve replacement

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0000000000000968 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Carmelo Dominici ◽

Antonio Salsano ◽

Antonio Nenna ◽

Cristiano Spadaccio ◽

Raffaele Barbato ◽

...

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Valve Replacement ◽

Left Atrial ◽

Transcatheter Aortic Valve Replacement ◽

Left Atrial Volume ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Transcatheter Aortic Valve

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Postoperative atrial fibrillation after aortic valve replacement is a risk factor for long-term atrial fibrillation

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz094 ◽

2019 ◽

Vol 29 (3) ◽

pp. 378-385 ◽

Cited By ~ 2

Author(s):

Rasmus Carter-Storch ◽

Jordi S Dahl ◽

Nicolaj L Christensen ◽

Redi Pecini ◽

Eva V Søndergård ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Atrial ◽

Left Atrial Volume ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index

AbstractOBJECTIVESPostoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. However, knowledge on the rate of long-term atrial fibrillation (LTAF) after POAF remains unclear. We investigated predictors of POAF in patients with aortic stenosis undergoing surgical aortic valve replacement, and assessed the rate of LTAF during follow-up.METHODSWe prospectively included 96 adult patients with severe aortic stenosis undergoing surgical aortic valve replacement. Patients with previous atrial fibrillation (AF) were excluded. Patients underwent echocardiography, cardiac computed tomography and magnetic resonance imaging immediately prior to surgery. Surgical aortic clamp time and postoperative C-reactive protein (CRP) were documented. POAF was defined as AF recorded within 7 days of surgery. Through chart review, patients were followed up for documented episodes of LTAF occurring more than 7 days after surgery.RESULTSPOAF occurred in 51 patients (53%). It was associated with larger preoperative echocardiographic left atrial volume index (44 ± 12 vs 37 ± 8 ml/m2, P = 0.004), longer aortic clamp time [80 (70–102) vs 72 (62–65) min, P = 0.04] and higher CRP on first postoperative day [80 (64–87) vs 65 (44–83) mg/l, P = 0.001]. Multivariable logistic regression revealed that left atrial volume index [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02–1.13; P = 0.005] and postoperative CRP (OR 1.03, 95% CI 1.01–1.05; P = 0.006) were the only independent predictors of POAF. During 695 days (25th–75th percentile: 498–859 days) of follow-up, LTAF occurred in 11 patients of whom 10 were in the POAF group (hazard ratio 9.4, 95% CI 1.2–74; P = 0.03).CONCLUSIONSPOAF is predicted by left atrial volume index and postoperative CRP. Patients with POAF have a 9-fold increase risk of developing symptomatic LTAF during follow-up.Clinical trial registration numberClinicalTrials.gov (NCT02316587).

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