Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Quebec, Canada.
Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Quebec, Canada.
Open Heart. 2023 Jul;10(2). doi: 10.1136/openhrt-2023-002361.
We aimed to assess the incremental prognostic value of N-terminal-pro-B-type natriuretic peptide (Nt-proBNP) for risk stratification in mixed aortic valve disease (MAVD) patients.
We included 556 (73±12 years, 37% women) consecutive patients with at least a moderate aortic stenosis (AS) or aortic regurgitation (AR) lesion with a concomitant AS or AR of any severity in whom Nt-proBNP was measured and expressed as its ratio (measured Nt-proBNP divided by the upper limit of normal Nt-proBNP for age and sex). The primary endpoint was all-cause mortality.
Baseline median Nt-proBNP ratio was 3.8 (IQR: 1.5-11.3), and the median follow-up was 5.6 years (4.8-6.1). Early aortic valve replacement (AVR) was performed within 3 months in 423 (76%) patients, while 133 (24%) remained initially under medical treatment. In comprehensive multivariable analyses, Nt-proBNP ratio was significantly associated with excess mortality (continuous variable: HR (95% CI): 1.24 (1.04 to 1.47), p=0.02; Nt-proBNP ratio ≥3: 2.41 (1.33 to 4.39), p=0.004). The independent prognostic value was also observed in patients with severe or non-severe AS/AR, and those treated by early-AVR (all p<0.04). Nt-proBNP ratio as continuous and dichotomic (≥3) variables showed incremental prognostic value (all net reclassification index >0.42, all p≤0.008). After early-AVR, Nt-proBNP ratio ≥3 was associated with higher 30-day mortality (9 (4%) vs 1 (0.5%), p=0.02).
In this series of MAVD patients, Nt-proBNP ratio was a powerful predictor of early and long-term mortality, even in patients with both non-severe AS/AR. Moreover, early-AVR may be an option for patients with Nt-proBNP ratio ≥3. Further randomised studies are needed to validate this last point.
我们旨在评估 N 末端前 B 型利钠肽（Nt-proBNP）在混合性主动脉瓣疾病（MAVD）患者风险分层中的增量预后价值。
我们纳入了 556 例（73±12 岁，37%为女性）连续患者，这些患者至少存在中度主动脉瓣狭窄（AS）或主动脉瓣反流（AR）病变，且同时存在任何严重程度的 AS 或 AR。测量并表示 Nt-proBNP 与其比值（测量的 Nt-proBNP 除以年龄和性别对应的 Nt-proBNP 正常上限）。主要终点是全因死亡率。
基线时中位 Nt-proBNP 比值为 3.8（IQR：1.5-11.3），中位随访时间为 5.6 年（4.8-6.1）。423 例（76%）患者在 3 个月内进行了早期主动脉瓣置换术（AVR），而 133 例（24%）最初仍接受药物治疗。在综合多变量分析中，Nt-proBNP 比值与超额死亡率显著相关（连续变量：HR（95%CI）：1.24（1.04 至 1.47），p=0.02；Nt-proBNP 比值≥3：2.41（1.33 至 4.39），p=0.004）。在严重或非严重 AS/AR 患者以及接受早期 AVR 治疗的患者中也观察到独立的预后价值（所有 p<0.04）。Nt-proBNP 比值作为连续和二分变量（≥3）显示出增量预后价值（所有净重新分类指数>0.42，所有 p≤0.008）。在早期 AVR 后，Nt-proBNP 比值≥3 与 30 天死亡率较高相关（9（4%）比 1（0.5%），p=0.02）。
在本系列 MAVD 患者中，Nt-proBNP 比值是早期和长期死亡率的有力预测因子，即使在非严重 AS/AR 患者中也是如此。此外，早期 AVR 可能是 Nt-proBNP 比值≥3 的患者的一种选择。需要进一步的随机研究来验证这最后一点。
