Prognostic Value of N-Terminal Pro–B-Type Natriuretic Peptide in Elderly Patients With Valvular Heart Disease
In: Journal of the American College of Cardiology, Jg. 75 (2020-04-01), S. 1659-1672
Online
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Zugriff:
N-terminal pro-B-type natriuretic peptide (NT-proBNP) may reflect early prognosis in patients with valvular heart disease (VHD).The aim of this study was to examine the association between NT-proBNP and mortality in elderly patients with VHD.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.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.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.
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Prognostic Value of N-Terminal Pro–B-Type Natriuretic Peptide in Elderly Patients With Valvular Heart Disease
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Autor/in / Beteiligte Person: | Zhang, Erli ; Qi, Xiling ; Zhang, Haitong ; Liu, Sisi ; Pibarot, Philippe ; Xu, Yujun ; Xu, Haiyan ; Ye, Yunqing ; Zhao, Qinghao ; Liu, Qingrong ; Clavel, Marie-Annick ; Gao, Runlin ; Zhang, Bin ; Wu, Yongjian ; Hao, Jie |
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Zeitschrift: | Journal of the American College of Cardiology, Jg. 75 (2020-04-01), S. 1659-1672 |
Veröffentlichung: | Elsevier BV, 2020 |
Medientyp: | unknown |
ISSN: | 0735-1097 (print) |
DOI: | 10.1016/j.jacc.2020.02.031 |
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