Left Ventricular Inflow to Outflow Angle and Brain Natriuretic Peptide Levels Post- Transcatheter Aortic Valve Implantation

Abstract Purpose Increased brain natriuretic peptide (BNP) post-transcatheter aortic valve implantation (TAVI) indicates poor clinical outcomes. Limited information exists on the predictors of increased BNP. This study aimed to evaluate whether the left ventricular inflow to outflow (LVIO) angle, assessd using computed tomography, is associated with BNP increase post-TAVI. Methods We assessed 144 consecutive patients who underwent transfemoral TAVI for native aortic stenosis without new-onset atrial fibrillation and pacemaker implantation post-TAVI. Based on the BNP ratio (BNP at 30 days post-TAVI / BNP pre-TAVI), we divided the patients into the BNP-rise (BNP ratio > 1) and non BNP-rise groups (BNP ratio ≤ 1), and compared the LVIO angle, as well as baseline, electrocardiographic, and echocardiographic characteristics between them. Results Forty-five (31%) patients were classified as BNP-rise. The systolic LVIO angle was significantly smaller in the BNP-rise than the non BNP-rise group (119.2° ± 7.2° vs. 124.3° ± 7.2°, P < 0.01); although, the mean aortic gradient, BNP level, and calcium volume of the aortic valve at baseline were significantly lower in the BNP-rise group. Procedural characteristics did not differ between the groups. A multivariate logistic regression analysis revealed that the systolic LVIO angle of < 118° was independently associated with increased BNP levels post-TAVI (Odd ratio 7.01, 95% confidence interval 2.37–20.79, P < 0.01), in addition to the mean aortic gradient and aortic valve calcium volume. Conclusions The systolic LVIO angle correlated with increase in BNP levels post-TAVI, independent of pre-procedural aortic stenosis severity. A small systolic LVIO angle may necessitate close follow-up post-TAVI.