N 末端脑利钠肽前体与经导管主动脉瓣置换术后的临床结局相关。

N-terminal pro-B-type natriuretic peptide is associated with clinical outcomes after transcatheter aortic valve replacement.

机构信息

Department of Structural Heart Disease Centre, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167, Beilishi Road, Xicheng District, Beijing, 100037, China.

出版信息

J Cardiothorac Surg. 2023 Oct 10;18(1):286. doi: 10.1186/s13019-023-02391-2.

DOI:10.1186/s13019-023-02391-2

PMID:37817246

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10566171/

Abstract

BACKGROUND

Limited data on the prognostic value of periprocedural changes of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) after transcatheter aortic valve replacement (TAVR).

METHODS

Data of plasma NT-proBNP were retrospectively collected in 357 patients before TAVR procedure and at discharge from January 1, 2018 to December 31, 2021 in our single center. Patients were grouped as responders and non-responders according to the NT-proBNP ratio (postprocedural NT-proBNP at discharge/ preprocedural NT-proBNP). Responders were defined as NT-proBNP ratio < 1 and non-responders were defined as NT-proBNP ratio ≥ 1. Outcomes were defined according to the Valve Academy Research Consortium (VARC)-3 criteria.

RESULTS

A total of 234 patients (65.5%) and 123 patients (34.5%) were grouped as the responders and the non-responders, respectively. Responders and non-responders were significantly different in both median preprocedural (2103.5 vs. 421.0 pg/ml, p < 0.001) and postprocedural (707.6 vs. 1009.0, p < 0.001) NT-proBNP levels. Patients in the non-responder group were more inclined to have comorbidities of hypertension (73.2% vs. 51.7%, p < 0.001), hyperlipidaemia (46.3% vs. 34.6%, p = 0.031), peripheral vascular disease (20.3% vs. 8.5%, p = 0.001) and pure aortic insufficiency (15.4% vs. 4.3%, p < 0.001). In the contrast, patients in the responder group had higher prevalence of maximum transvalvular velocity (4.6 vs. 4.2 m/s, p < 0.001), reduced left ventricular ejection fraction (58.0% vs. 63.0%, p < 0.001), heart failure (9.4% vs. 2.4%, p = 0.014), mitral regurgitation ≥ moderate (13.7% vs. 4.9%, p = 0.010), tricuspid regurgitation ≥ moderate (12.0% vs. 2.4%, p = 0.002), and pulmonary hypertension (32.9% vs. 13.0%, p < 0.001). Patients in the non-responder group were moderately longer than the responder group in total hospitalization length (14 vs. 12 days, p < 0.001). The non-responder group were significantly associated with cumulative all-cause mortality (p = 0.009) and cardiac mortality (p < 0.001) during the follow-up period.

CONCLUSIONS

Periprocedural changes of NT-proBNP is clinically useful for the risk stratification of survival in patients after TAVR.

摘要

背景

经导管主动脉瓣置换术（TAVR）后，血浆 N 末端 B 型利钠肽前体（NT-proBNP）的围手术期变化对预后的预测价值数据有限。

方法

回顾性收集了 2018 年 1 月 1 日至 2021 年 12 月 31 日在我院行 TAVR 手术的 357 例患者的术前和出院时的血浆 NT-proBNP 数据。根据 NT-proBNP 比值（术后 NT-proBNP 与术前 NT-proBNP 的比值）将患者分为反应者和非反应者。反应者定义为 NT-proBNP 比值<1，非反应者定义为 NT-proBNP 比值≥1。根据 Valve Academy Research Consortium（VARC）-3 标准定义结局。

结果

共有 234 例（65.5%）和 123 例（34.5%）患者分别被分为反应者和非反应者。反应者和非反应者在术前（2103.5 比 421.0 pg/ml，p<0.001）和术后（707.6 比 1009.0，p<0.001）NT-proBNP 水平方面有显著差异。非反应者组的合并症更倾向于高血压（73.2%比 51.7%，p<0.001）、高脂血症（46.3%比 34.6%，p=0.031）、外周血管疾病（20.3%比 8.5%，p=0.001）和单纯主动脉瓣关闭不全（15.4%比 4.3%，p<0.001）。相比之下，反应者组的最大跨瓣速度更高（4.6 比 4.2 m/s，p<0.001），左心室射血分数更低（58.0%比 63.0%，p<0.001），心力衰竭发生率更高（9.4%比 2.4%，p=0.014），二尖瓣反流≥中度（13.7%比 4.9%，p=0.010），三尖瓣反流≥中度（12.0%比 2.4%，p=0.002），肺动脉高压发生率更高（32.9%比 13.0%，p<0.001）。非反应者组的总住院时间比反应者组略长（14 比 12 天，p<0.001）。非反应者与随访期间的全因死亡率（p=0.009）和心脏死亡率（p<0.001）显著相关。