AIMS B-type natriuretic peptide (BNP) is a cardiac neurohormone that is secreted in response to ventricular volume expansion and pressure overload. There are conflicting data regarding the association between BNP levels and outcomes after transcatheter aortic valve replacement (TAVR). We therefore sought to assess the association between baseline BNP and adverse outcomes in patients with symptomatic, severe aortic stenosis (AS), and left ventricular ejection fraction (LVEF) ≥50%, undergoing TAVR in the PARTNER 2 Trial and Registry. METHODS AND RESULTS A total of 1782 patients were included in the analysis, and BNP was evaluated both as a continuous log-transformed value and by a priori categories: low (<50 pg/mL), normal (≥50 and <100 pg/mL), moderately elevated (≥100 and <400 pg/mL), or markedly elevated (≥400 pg/mL). Clinical outcomes from discharge to 2 years were compared between patients according to their baseline BNP level, using Kaplan-Meier event rates and multivariable Cox proportional hazards regression models. After adjustment, spline curves revealed a non-linear association between log-transformed BNP and all-cause and cardiovascular mortality in which both the lowest and highest values were associated with increased mortality. Two-year all-cause mortality rates for those with low (n = 86), normal (n = 202), moderately elevated (n = 885), and markedly elevated (n = 609) baseline BNP were 20.0%, 9.8%, 17.7%, and 26.1%, respectively. In adjusted models, compared to a normal baseline BNP, low [adjusted hazard ratio (HR) 2.6, 95% confidence interval (CI) 1.3-5.0, P-value 0.005], moderately elevated (adjusted HR 1.6, 95% CI 1.0-2.6, P-value 0.06), and markedly elevated (adjusted HR 2.1, 95% CI 1.3-3.5, P-value 0.003) BNP were associated with increased all-cause mortality, driven by cardiovascular mortality. CONCLUSIONS In a large cohort of patients with severe symptomatic AS and preserved LVEF undergoing TAVR, all-cause and cardiovascular mortality rates at 2 years were higher in patients with low and markedly elevated BNP levels. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ unique identifier #NCT01314313, #NCT02184442, #NCT03222128, and #NCT03222141.

中文翻译：

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B 型利钠肽水平低和升高与射血分数保留接受经导管主动脉瓣置换术的患者死亡率增加相关：对 PARTNER II 试验和登记的分析

AIMS B 型利钠肽 (BNP) 是一种心脏神经激素，可响应心室容量扩张和压力超负荷而分泌。关于 BNP 水平与经导管主动脉瓣置换术 (TAVR) 后结果之间的关系存在相互矛盾的数据。因此，我们试图评估在 PARTNER 2 试验和登记中接受 TAVR 的有症状、严重主动脉瓣狭窄 (AS) 和左心室射血分数 (LVEF) ≥50% 的患者的基线 BNP 与不良结果之间的关联。方法和结果 共有 1782 名患者被纳入分析，BNP 被评估为连续对数转换值和先验分类：低（<50 pg/mL）、正常（≥50 和 <100 pg/ mL）、中度升高（≥100 且 <400 pg/mL）或显着升高（≥400 pg/mL）。使用 Kaplan-Meier 事件发生率和多变量 Cox 比例风险回归模型，根据患者的基线 BNP 水平比较患者出院至 2 年的临床结果。调整后，样条曲线显示对数转换后的 BNP 与全因和心血管死亡率之间存在非线性关联，其中最低和最高值都与死亡率增加相关。基线 BNP 低 (n = 86)、正常 (n = 202)、中度升高 (n = 885) 和显着升高 (n = 609) 的患者的两年全因死亡率分别为 20.0%、9.8%、分别为 17.7% 和 26.1%。在调整后的模型中，与正常基线 BNP 相比，低 [调整后的风险比 (HR) 2.6，95% 置信区间 (CI) 1.3-5.0，P 值 0.005]，中度升高（调整后的 HR 1.6，95% CI 1.0- 2.6，P 值 0.06），和显着升高（调整后的 HR 2.1，95% CI 1.3-3.5，P 值 0.003）BNP 与心血管死亡率驱动的全因死亡率增加相关。结论 在一大群接受 TAVR 的严重症状性 AS 和保留 LVEF 的患者中，BNP 水平低和显着升高的患者 2 年全因死亡率和心血管死亡率较高。临床试验注册 https://clinicaltrials.gov/ 唯一标识符#NCT01314313、#NCT02184442、#NCT03222128 和#NCT03222141。BNP 水平低和显着升高的患者 2 年全因死亡率和心血管死亡率较高。临床试验注册 https://clinicaltrials.gov/ 唯一标识符#NCT01314313、#NCT02184442、#NCT03222128 和#NCT03222141。BNP 水平低和显着升高的患者 2 年全因死亡率和心血管死亡率较高。临床试验注册 https://clinicaltrials.gov/ 唯一标识符#NCT01314313、#NCT02184442、#NCT03222128 和#NCT03222141。