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Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease
OBJECTIVE: 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. METHODS: We included 556 (73±12 years, 37% women) consecutive patients with at least a moderate aortic stenos...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357672/ https://www.ncbi.nlm.nih.gov/pubmed/37474135 http://dx.doi.org/10.1136/openhrt-2023-002361 |
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author | Bernard, Jérémy Jean, Guillaume Bienjonetti-Boudreau, David Jacques, Frédéric Tastet, Lionel Salaun, Erwan Clavel, Marie-Annick |
author_facet | Bernard, Jérémy Jean, Guillaume Bienjonetti-Boudreau, David Jacques, Frédéric Tastet, Lionel Salaun, Erwan Clavel, Marie-Annick |
author_sort | Bernard, Jérémy |
collection | PubMed |
description | OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. |
format | Online Article Text |
id | pubmed-10357672 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-103576722023-07-21 Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease Bernard, Jérémy Jean, Guillaume Bienjonetti-Boudreau, David Jacques, Frédéric Tastet, Lionel Salaun, Erwan Clavel, Marie-Annick Open Heart Valvular Heart Disease OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. BMJ Publishing Group 2023-07-19 /pmc/articles/PMC10357672/ /pubmed/37474135 http://dx.doi.org/10.1136/openhrt-2023-002361 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Valvular Heart Disease Bernard, Jérémy Jean, Guillaume Bienjonetti-Boudreau, David Jacques, Frédéric Tastet, Lionel Salaun, Erwan Clavel, Marie-Annick Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease |
title | Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease |
title_full | Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease |
title_fullStr | Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease |
title_full_unstemmed | Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease |
title_short | Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease |
title_sort | prognostic utility of n-terminal pro b-type natriuretic peptide ratio in mixed aortic valve disease |
topic | Valvular Heart Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357672/ https://www.ncbi.nlm.nih.gov/pubmed/37474135 http://dx.doi.org/10.1136/openhrt-2023-002361 |
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