Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
Heart. 2013 Apr;99(7):461-7. doi: 10.1136/heartjnl-2012-303284. Epub 2013 Jan 24.
Previous studies suggested an independent prognostic value of B-type natriuretic peptide (BNP) in aortic valve stenosis (AS) but were impeded by small sample sizes and inclusion of relatively selected young patients. We aimed to evaluate the relationship among N-terminal fragment of proBNP (Nt-proBNP), AS severity, symptoms and outcome in a large cohort of elderly patients with AS.
Observational cohort study, COhorte Française de Retrecissement Aortique du Sujet Agé (clinicalTrial.gov number-NCT00338676) and GENEtique du Retrecissement Aortique (clinicalTrial.gov number-NCT00647088).
Single-centre study.
Patients older than 70 years with at least mild AS.
None.
A comprehensive clinical, biological and echocardiographic evaluation was performed at study entry. Asymptomatic patients were prospectively followed on a 6-months basis and AS-related events (sudden death, congestive heart failure or new onset of AS-related symptoms) collected.
We prospectively enrolled 361 patients (79±6 years, 230 severe AS). Nt-proBNP increased with the grade of AS severity and the NYHA class (all p<0.0001) but there was an important overlap between grades/classes. Consequently, diagnostic value of Nt-proBNP for the diagnosis of severe symptomatic AS was only modest (area under the curve of the receiver operator characteristic analysis=0.73). At 2 years, 28 AS-related events occurred among 142 asymptomatic patients prospectively followed. Nt-proBNP was associated with outcome in univariate analysis (p=0.04) but not after adjustment for age, gender and AS severity (p=0.40).
The present study clearly highlights the limitations of Nt-proBNP for the evaluation and management of AS patients. Our results suggest that Nt-proBNP should be considered cautiously, at least as a single criterion, in the decision-making process of AS patients especially in the elderly population.
先前的研究表明，B 型利钠肽（BNP）在主动脉瓣狭窄（AS）中具有独立的预后价值，但由于样本量小且纳入了相对选择的年轻患者，这些研究受到了阻碍。我们旨在评估在一个大型的老年 AS 患者队列中，氨基末端脑钠肽前体（Nt-proBNP）与 AS 严重程度、症状和预后之间的关系。
观察性队列研究，COhorte Française de Retrecissement Aortique du Sujet Agé（clinicalTrial.gov 编号-NCT00338676）和 GENEtique du Retrecissement Aortique（clinicalTrial.gov 编号-NCT00647088）。
单中心研究。
年龄大于 70 岁且至少有轻度 AS 的患者。
无。
在研究开始时进行全面的临床、生物学和超声心动图评估。无症状患者进行了前瞻性的 6 个月随访，并收集了与 AS 相关的事件（猝死、充血性心力衰竭或新发 AS 相关症状）。
我们前瞻性纳入了 361 名患者（79±6 岁，230 名严重 AS）。Nt-proBNP 随 AS 严重程度和 NYHA 分级的增加而增加（均 p<0.0001），但各分级/级别之间存在很大的重叠。因此，Nt-proBNP 对诊断严重有症状性 AS 的诊断价值仅为中等（接受者操作特征分析曲线下面积=0.73）。在 2 年的随访中，142 名前瞻性随访的无症状患者中有 28 例发生了与 AS 相关的事件。在单因素分析中，Nt-proBNP 与结果相关（p=0.04），但在校正年龄、性别和 AS 严重程度后（p=0.40），相关性消失。
本研究清楚地强调了 Nt-proBNP 在评估和管理 AS 患者方面的局限性。我们的结果表明，在 AS 患者的决策过程中，特别是在老年人群中，Nt-proBNP 应该谨慎考虑，至少不应作为单一标准。
