Auensen Andreas, Hussain Amjad Iqbal, Falk Ragnhild Sørum, Walle-Hansen Marte Meyer, Bye Jorun, Pettersen Kjell Ingar, Aukrust Pål, Ueland Thor, Gullestad Lars Lysgaard
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Centre for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway.
PLoS One. 2017 Jun 12;12(6):e0179304. doi: 10.1371/journal.pone.0179304. eCollection 2017.
Among patients with severe aortic stenosis (AS), we investigated the associations of N-terminal pro-natriuretic peptide (NT-proBNP), high-sensitive troponin T (hsTnT), and high-sensitive C-reactive protein (hs-CRP) with 3-year mortality and major adverse cardiovascular events (MACE) during 1 year.
This observational cohort study prospectively enrolled 442 patients with severe AS who were referred for evaluation of possible valve replacement. Clinical data was recorded before the decision of whether to operate was made. We studied the prognostic value of assessing biomarkers by serum levels, and tested associations of NT-proBNP, hsTnT, and hs-CRP with clinical outcomes (3-year all-cause mortality and risk of MACE in the year following study inclusion) using adjusted multivariable analysis.
Elevated serum levels of these biomarkers at baseline evaluation were associated with increased all-cause 3-year mortality regardless of treatment assignment. Adjusted analysis showed that none of the studied biomarkers (NT-proBNP, hsTnT or hs-CRP) or any other covariates were associated with 3-year all-cause mortality following surgical aortic valve replacement (SAVR). However, adjusted analyses showed that hsTnT (HR, 1.51; 95% CI, 1.11-2.05; P = 0.008) and left ventricular ejection fraction (HR 0.97; 95% CI 0.94-0.97, P = 0.043) was associated with MACE for operated patients.
Whereas NT-proBNP, hsTnT and hs-CRP had no independently prognostic value in relation to all-cause mortality following SAVR, hsTnT was independently associated with MACE following operation. The use of these clinically available biomarkers, in particular hsTnT, should be clarified in larger studies.
在重度主动脉瓣狭窄（AS）患者中，我们研究了N末端B型利钠肽原（NT-proBNP）、高敏肌钙蛋白T（hsTnT）和高敏C反应蛋白（hs-CRP）与3年死亡率及1年内主要不良心血管事件（MACE）之间的关联。
这项观察性队列研究前瞻性纳入了442例因可能需要瓣膜置换而转诊评估的重度AS患者。在决定是否进行手术之前记录临床数据。我们通过血清水平研究了评估生物标志物的预后价值，并使用校正后的多变量分析测试了NT-proBNP、hsTnT和hs-CRP与临床结局（3年全因死亡率以及纳入研究后1年的MACE风险）之间的关联。
在基线评估时，这些生物标志物的血清水平升高与全因3年死亡率增加相关，无论治疗分配如何。校正分析显示，所研究的生物标志物（NT-proBNP、hsTnT或hs-CRP）或任何其他协变量均与外科主动脉瓣置换术（SAVR）后的3年全因死亡率无关。然而，校正分析显示，hsTnT（风险比[HR]，1.51；95%置信区间[CI]，1.11 - 2.05；P = 0.008）和左心室射血分数（HR 0.97；95% CI 0.94 - 0.97，P = 0.043）与接受手术患者的MACE相关。
虽然NT-proBNP、hsTnT和hs-CRP在SAVR后的全因死亡率方面没有独立的预后价值，但hsTnT与术后MACE独立相关。在更大规模的研究中应明确这些临床可用生物标志物，尤其是hsTnT的用途。
