PMID- 37474135 OWN - NLM STAT- MEDLINE DCOM- 20230724 LR - 20230725 IS - 2053-3624 (Print) IS - 2053-3624 (Electronic) IS - 2053-3624 (Linking) VI - 10 IP - 2 DP - 2023 Jul TI - Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease. LID - 10.1136/openhrt-2023-002361 [doi] LID - e002361 AB - 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/=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. CI - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. FAU - Bernard, Jeremy AU - Bernard J AUID- ORCID: 0000-0002-0645-2636 AD - Cardiology, Institut universitaire de cardiologie et de pneumologie de Quebec - Universite Laval, Quebec, Quebec, Canada. FAU - Jean, Guillaume AU - Jean G AD - Cardiology, Institut universitaire de cardiologie et de pneumologie de Quebec - Universite Laval, Quebec, Quebec, Canada. FAU - Bienjonetti-Boudreau, David AU - Bienjonetti-Boudreau D AD - Cardiology, Institut universitaire de cardiologie et de pneumologie de Quebec - Universite Laval, Quebec, Quebec, Canada. FAU - Jacques, Frederic AU - Jacques F AD - Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Quebec - Universite Laval, Quebec, Quebec, Canada. FAU - Tastet, Lionel AU - Tastet L AD - Cardiology, Institut universitaire de cardiologie et de pneumologie de Quebec - Universite Laval, Quebec, Quebec, Canada. FAU - Salaun, Erwan AU - Salaun E AD - Cardiology, Institut universitaire de cardiologie et de pneumologie de Quebec - Universite Laval, Quebec, Quebec, Canada. FAU - Clavel, Marie-Annick AU - Clavel MA AUID- ORCID: 0000-0002-8924-740X AD - Cardiology, Institut universitaire de cardiologie et de pneumologie de Quebec - Universite Laval, Quebec, Quebec, Canada marie-annick.clavel@criucpq.ulaval.ca. LA - eng GR - CIHR/Canada PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Open Heart JT - Open heart JID - 101631219 RN - 0 (Biomarkers) RN - 114471-18-0 (Natriuretic Peptide, Brain) RN - 0 (Peptide Fragments) RN - 0 (pro-brain natriuretic peptide (1-76)) SB - IM MH - Female MH - Humans MH - Male MH - *Aortic Valve Insufficiency/surgery MH - *Aortic Valve Stenosis/diagnosis/surgery MH - Biomarkers MH - Natriuretic Peptide, Brain MH - Peptide Fragments MH - Prognosis MH - Middle Aged MH - Aged MH - Aged, 80 and over PMC - PMC10357672 OTO - NOTNLM OT - Aortic Valve Insufficiency OT - Aortic Valve Stenosis OT - Biomarkers OT - Outcome Assessment, Health Care COIS- Competing interests: M-AC received funding from Edwards Lifesciences for CT core laboratory analyses in the field of surgical aortic valve prosthesis with no direct personal compensation and research grant from Medtronic. The other authors have no conflict of interest relevant to the contents of this paper to declare. EDAT- 2023/07/21 01:11 MHDA- 2023/07/24 06:42 PMCR- 2023/07/19 CRDT- 2023/07/20 20:42 PHST- 2023/05/09 00:00 [received] PHST- 2023/06/30 00:00 [accepted] PHST- 2023/07/24 06:42 [medline] PHST- 2023/07/21 01:11 [pubmed] PHST- 2023/07/20 20:42 [entrez] PHST- 2023/07/19 00:00 [pmc-release] AID - openhrt-2023-002361 [pii] AID - 10.1136/openhrt-2023-002361 [doi] PST - ppublish SO - Open Heart. 2023 Jul;10(2):e002361. doi: 10.1136/openhrt-2023-002361.