Gomez Perez Miquel, Ble Mireia, Cladellas Mercedes, Molina Lluis, Vila Joan, Mas-Stachurska Alexandra, Higueras-Ortega Laura, Marti-Almor Julio
Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Int J Cardiol. 2017 Feb 1;228:890-894. doi: 10.1016/j.ijcard.2016.11.144. Epub 2016 Nov 10.
Tissue Doppler imaging (TDI) and N-terminal-pro-Brain Natriuretic Peptide (NT-proBNP) provides useful non-invasive information about left ventricle filling pressures and both have demonstrated to be a prognostic marker in some valve disease as aortic stenosis (AS).
To assess the clinical value of combined TDI and NT-proBNP information in asymptomatic AS patients.
Prospective study of 350 initially asymptomatic moderate to severe AS patients with: Mean aortic valve area 0.8 (0.3) cm, mean gradient 45(13) mmHg, ejection fraction 61 (9) %. Mean age: 74.6 (4.3) years. In all patients were determined NT-proBNP in the serum and TDI parameters the lateral mitral annulus. We considered clinical event the admission in the hospital due to symptoms related to AS (angina, heart failure or syncope) as well as surgical treatment or mortality.
After a mean follow-up of 29 (10) months, 165 (47%) patients suffered some clinical event. In order to predict clinical events, Bootstrap analysis determined the best cut-point value: E/E' ratio higher than 13 and NT-proBNP higher than 515pg/mL. E/E' ratio provides more specificity (78.9% vs 55.9%) and NT-proBNP provides more sensitivity (76.6% vs 43.7%). Combined use of both parameters provides the best prognostic information (sensitivity 75.6%, specificity 67.2%, negative predictive value 82.1%, positive predictive value 57.5%, accuracy 71.4%).
Combined use of TDI and natriuretic peptides information provides incremental prognostic value and is a useful tool to predict the prognosis in asymptomatic AS patients.
组织多普勒成像（TDI）和N末端脑钠肽前体（NT-proBNP）可提供有关左心室充盈压的有用非侵入性信息，并且二者均已被证明是某些瓣膜疾病（如主动脉瓣狭窄（AS））的预后标志物。
评估TDI和NT-proBNP联合信息在无症状AS患者中的临床价值。
对350例最初无症状的中重度AS患者进行前瞻性研究，患者平均主动脉瓣面积为0.8（0.3）平方厘米，平均压差为45（13）毫米汞柱，射血分数为61（9）%。平均年龄：74.6（4.3）岁。对所有患者测定血清中的NT-proBNP以及二尖瓣环外侧的TDI参数。我们将因AS相关症状（心绞痛、心力衰竭或晕厥）入院、接受手术治疗或死亡视为临床事件。
平均随访29（10）个月后，165例（47%）患者发生了一些临床事件。为了预测临床事件，Bootstrap分析确定了最佳切点值：E/E'比值高于13且NT-proBNP高于515皮克/毫升。E/E'比值具有更高的特异性（78.9%对55.9%），NT-proBNP具有更高的敏感性（76.6%对43.7%）。联合使用这两个参数可提供最佳的预后信息（敏感性75.6%，特异性67.2%，阴性预测值82.1%，阳性预测值57.5%，准确性71.4%）。
TDI和利钠肽信息的联合使用可提供额外的预后价值，是预测无症状AS患者预后的有用工具。
