Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2020 May 15;125(10):1566-1570. doi: 10.1016/j.amjcard.2020.02.004. Epub 2020 Feb 11.
Plasma B-type natriuretic peptide (BNP) and its N-terminal pro-form, NT-proBNP, can predict outcomes in patients with severe aortic stenosis (AS). However, their prognostic value in moderate AS is currently unknown. The present study included 261 patients diagnosed with moderate AS (1.0 <aortic valve area ≤1.5 cm) in 2012 with serum NT-pro BNP level collected within ±3 months of the echocardiographic assessment. Patients were divided into 2 groups according to the median NT-proBNP value (888 pg/dl) and all-cause mortality compared. Median age was 78 years and 64% of patients were male. There were 131 (50%) patients with lower-median NT-pro BNP levels (≤888 pg/dl) and 130 (50%) with higher-median NT-pro BNP levels (>888 pg/dl). During a median follow up of 2.7 years, there were 136 (52%) deaths. Mortality rate was much higher in patients with higher-median NT-pro BNP compared to those with lower-median NT-pro BNP levels (p <0.001). Higher-median NT-pro BNP level was significantly associated with higher mortality rate (hazard ratio 3.11; 95% confidence interval 1.78 to 5.46, p <0.001) even after adjusting for confounders. Aortic valve replacement (AVR) was performed in 82 (31%) patients and median time to AVR was 2.1 years. Patients with higher-median NT-pro BNP had higher mortality rate compared to patients with lower-median NT-pro BNP even after AVR (p <0.01). In conclusion, higher NT-proBNP level is associated with higher mortality rates in patients with moderate AS even among those undergoing AVR.
血浆 B 型利钠肽（BNP）及其 N 端前体肽，NT-proBNP，可预测严重主动脉瓣狭窄（AS）患者的结局。然而，其在中度 AS 中的预后价值目前尚不清楚。本研究纳入了 2012 年诊断为中度 AS（1.0<aortic valve area ≤1.5 cm）的 261 例患者，在超声心动图评估的±3 个月内采集了血清 NT-pro BNP 水平。根据 NT-proBNP 中位数（888 pg/dl）将患者分为两组，并比较全因死亡率。中位年龄为 78 岁，64%的患者为男性。有 131 例（50%）患者的 NT-proBNP 中位数水平较低（≤888 pg/dl），130 例（50%）患者的 NT-proBNP 中位数水平较高（>888 pg/dl）。中位随访 2.7 年后，有 136 例（52%）死亡。与 NT-proBNP 中位数水平较低的患者相比，NT-proBNP 中位数水平较高的患者死亡率更高（p<0.001）。即使在调整混杂因素后，NT-proBNP 中位数水平较高与较高的死亡率显著相关（风险比 3.11；95%置信区间 1.78 至 5.46，p<0.001）。82 例（31%）患者接受了主动脉瓣置换术（AVR），中位 AVR 时间为 2.1 年。与 NT-proBNP 中位数水平较低的患者相比，NT-proBNP 中位数水平较高的患者即使在接受 AVR 后死亡率也更高（p<0.01）。总之，即使在接受 AVR 的患者中，中度 AS 患者 NT-proBNP 水平较高与较高的死亡率相关。
