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Prognostic Value of N-Terminal Pro–B-Type Natriuretic Peptide in Elderly Patients With Valvular Heart Disease
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2020-04-01 , DOI: 10.1016/j.jacc.2020.02.031
Bin Zhang , Haiyan Xu , Haitong Zhang , Qingrong Liu , Yunqing Ye , Jie Hao , Qinghao Zhao , Xiling Qi , Sisi Liu , Erli Zhang , Yujun Xu , Runlin Gao , Philippe Pibarot , Marie-Annick Clavel , Yongjian Wu

BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) may reflect early prognosis in patients with valvular heart disease (VHD). OBJECTIVES The aim of this study was to examine the association between NT-proBNP and mortality in elderly patients with VHD. METHODS A total of 5,983 elderly patients (age ≥60 years) with moderate or severe VHD underwent echocardiography and NT-proBNP measurement. VHD examined included aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid regurgitation, and multivalvular heart disease. NT-proBNP ratio was defined as measured NT-proBNP relative to the maximal normal values specific to age and sex. Disease-specific thresholds were defined on the basis of penalized splines and maximally selected rank statistics. RESULTS The cohort had a mean age of 71.1 ± 7.6 years. At 1-year follow-up, 561 deaths (9.4%) had occurred. In penalized splines, relative hazards showed a monotonic increase with greater NT-proBNP ratio for death with different VHDs (p < 0.001 for all) except mitral stenosis. Higher NT-proBNP ratio, categorized by disease-specific thresholds, was independently associated with mortality (overall adjusted hazard ratio: 1.99; 95% confidence interval: 1.76 to 2.24; p < 0.001). Different subtypes of VHD all incurred excess mortality with elevated NT-proBNP ratio, with the strongest association detected for aortic stenosis (adjusted hazard ratio: 10.5; 95% confidence interval: 3.9 to 28.27; p < 0.001). The addition of NT-proBNP ratio to the prediction algorithm including traditional risk factors improved outcome prediction (overall net reclassification index = 0.28; 95% CI: 0.24 to 0.34; p < 0.001; likelihood ratio test p < 0.001). Results remained consistent in patients under medical care, with normal left ventricular ejection fractions, and with primary VHD. CONCLUSIONS NT-proBNP provides incremental prognostic information for mortality in various VHDs. It could aid in risk stratification as a pragmatic and versatile biomarker in elderly patients.

中文翻译:

N端前B型利钠肽对老年心脏瓣膜病患者的预后价值

背景 N 端 B 型利钠肽原 (NT-proBNP) 可能反映心脏瓣膜病 (VHD) 患者的早期预后。目的 本研究的目的是检查 NT-proBNP 与老年 VHD 患者死亡率之间的关联。方法 共有 5,983 名患有中度或重度 VHD 的老年患者(年龄≥60 岁)接受了超声心动图和 NT-proBNP 测量。检查的 VHD 包括主动脉瓣狭窄、主动脉瓣关闭不全、二尖瓣狭窄、二尖瓣关闭不全、三尖瓣关闭不全和多瓣性心脏病。NT-proBNP 比率定义为测量的 NT-proBNP 相对于特定于年龄和性别的最大正常值。根据惩罚样条和最大选择的等级统计定义疾病特定阈值。结果 该队列的平均年龄为 71.1 ± 7.6 岁。在 1 年的随访中,发生了 561 例死亡(9.4%)。在惩罚样条中,除了二尖瓣狭窄外,相对危险显示出随着 NT-proBNP 比率的增加,不同 VHD 的死亡(所有 p < 0.001)单调增加。按疾病特异性阈值分类的较高 NT-proBNP 比率与死亡率独立相关(总体调整风险比:1.99;95% 置信区间:1.76 至 2.24;p < 0.001)。不同亚型的 VHD 都因 NT-proBNP 比率升高而导致死亡率过高,检测到主动脉瓣狭窄的关联最强(调整后的风险比:10.5;95% 置信区间:3.9 至 28.27;p < 0.001)。将 NT-proBNP 比率添加到包括传统风险因素在内的预测算法中改进了结果预测(总体净重分类指数 = 0.28;95% CI:0.24 至 0.34;p < 0。001; 似然比检验 p < 0.001)。结果在接受医疗护理的患者中保持一致,左心室射血分数正常,原发性 VHD。结论 NT-proBNP 为各种 VHD 的死亡率提供了增量预后信息。作为老年患者的实用且通用的生物标志物,它可以帮助风险分层。
更新日期:2020-04-01
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