Sasaki Shunsuke, Daimon Masao, Kawata Takayuki, Miyazaki Sakiko, Ichikawa Ryoko, Maruyama Masaki, Chiang Shuo-Ju, Mahara Keitaro, Watanabe Hiroyuki, Sumiyoshi Tetsuya, Tomoike Hitonobu, Daida Hiroyuki
Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
J Cardiol. 2014 Dec;64(6):476-81. doi: 10.1016/j.jjcc.2014.03.005. Epub 2014 May 5.
Elevated plasma B-type natriuretic peptide (BNP) is a predictor of outcome and helpful for risk stratification in aortic stenosis (AS). However, left ventricular (LV) diastolic dysfunction progresses with aging and may also influence plasma BNP levels in elderly patients. We hypothesized that plasma BNP levels may be influenced by age in severe AS, and that factors that affect the elevation of plasma BNP levels may be different between elderly and younger patients with AS.
We performed echocardiography in 341 patients with severe AS [aortic valve area (AVA)<1.0cm(2)] and classified them into two groups by age (elderly ≥75 years old, n=201; younger patients <75 years old, n=140). We used multivariate linear regression analysis to assess the factors that determine plasma BNP levels in both groups.
Age was found to be one of the independent determinants of plasma BNP levels in all patients (β=0.135, p=0.005). Although AVA was similar in the two groups, plasma BNP levels and E/e' were significantly higher in elderly than younger patients [133.0 (IQR, 73.3-329.7)pg/dl vs 92.8 (IQR, 40.6-171.8)pg/dl, p<0.01; 20±8 vs 16±6, p<0.01, respectively). In multivariate stepwise linear regression analysis, AVA index, LV ejection fraction, mass index, E/e', estimated systolic pulmonary artery pressure (eSPAS), and the presence of atrial fibrillation were independent determinants of plasma BNP levels in younger patients. In contrast, the independent determinants of plasma BNP levels in elderly patients were LV ejection fraction, mass index, E/e', eSPAS, the presence of atrial fibrillation, age, and hemoglobin levels, but not AVA index.
There may be differences in the factors that influence plasma BNP levels between elderly and younger patients with severe AS. In elderly patients, plasma BNP levels may be influenced more by these factors than AS severity compared with younger patients.
血浆B型利钠肽（BNP）升高是主动脉瓣狭窄（AS）患者预后的预测指标，有助于进行危险分层。然而，左心室（LV）舒张功能障碍会随着年龄增长而进展，也可能影响老年患者的血浆BNP水平。我们推测，在重度AS患者中，血浆BNP水平可能受年龄影响，并且在老年和年轻AS患者中，影响血浆BNP水平升高的因素可能有所不同。
我们对341例重度AS患者[主动脉瓣面积（AVA）<1.0cm²]进行了超声心动图检查，并根据年龄将他们分为两组（老年组≥75岁，n = 201；年轻患者<75岁，n = 140）。我们使用多元线性回归分析来评估两组中决定血浆BNP水平的因素。
年龄被发现是所有患者血浆BNP水平的独立决定因素之一（β = 0.135，p = 0.005）。尽管两组的AVA相似，但老年患者的血浆BNP水平和E/e'显著高于年轻患者[133.0（四分位间距，73.3 - 329.7）pg/dl对92.8（四分位间距，40.6 - 171.8）pg/dl，p < 0.01；分别为20±8对16±6，p < 0.01]。在多元逐步线性回归分析中，AVA指数、左心室射血分数、质量指数、E/e'、估计的收缩期肺动脉压（eSPAS）和房颤的存在是年轻患者血浆BNP水平的独立决定因素。相比之下，老年患者血浆BNP水平的独立决定因素是左心室射血分数、质量指数、E/e'、eSPAS、房颤的存在、年龄和血红蛋白水平，但不包括AVA指数。
老年和年轻重度AS患者中，影响血浆BNP水平的因素可能存在差异。与年轻患者相比，在老年患者中，血浆BNP水平可能更多地受这些因素影响，而非AS严重程度。
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