Utility of High-Sensitivity Cardiac Troponin-T and N-Terminal Pro-B-Type Natriuretic Peptide to Predict Survival, Quality of Life, and Functional Status Changes After Transcatheter Aortic Valve Implantation

BACKGROUND: Cardiac biomarkers are minimally incorporated into current aortic valve guidelines, except for elevated BNP (B-type natriuretic peptide) in asymptomatic severe aortic stenosis. This prospective observational cohort studied how pretranscatheter aortic valve implantation (TAVI) NT-proBNP (N-terminal proBNP) and hs-cTnT (high-sensitivity cardiac troponin T) relate to mortality, quality of life, and functional outcomes after TAVI. METHODS: This is a prospective cohort study of 173 patients undergoing TAVI at a large medical center in the United States between January 1, 2020, and January 1, 2022. NT-pro-BNP and hs-cTnT, Kansas City Cardiomyopathy Questionnaire, 6-minute walk distance, and mortality were surveilled pre TAVI, and at 30 days, 1 year, and 2 years post TAVI. The patients represented a real-world cohort of patients receiving TAVI. RESULTS: Two-year mortality for the entire cohort was 7.51% (13/173). In univariable analysis, higher baseline NT-pro-BNP and hs-cTnT were predictors of mortality at 2 years after TAVI. After adjusting for covariables, baseline hs-cTnT demonstrated a clinically meaningful association with mortality (P=0.058; odds ratio [OR], 2.74 [95% CI, 0.967-7.734]). In multivariable analysis, a combination variable of tertiled baseline hs-cTnT and NT-pro-BNP was a significant predictor of 2-year mortality; specifically, 2-year mortality rates stratified by combined score values of 6, 5, 4, 3, and 2 were 16.1%, 13.8%, 7.3%, 0%, and 0%, respectively. CONCLUSIONS: Those with an elevated combination biomarker variable-NT-pro-BNP >357 pg/mL and hs-cTnT >14.1 ng/L-should be most rigorously surveilled and managed before and after TAVI with more frequent and comprehensive outpatient visits for medical optimization of cardiac and noncardiac disease states.