Prognostic relevance of B‐type natriuretic peptide in patients with moderate mixed aortic valve disease

Abstract

Aims Data on B‐type natriuretic peptide (BNP) levels and adverse outcomes in patients with moderate mixed aortic valve disease (MAVD), defined as moderate aortic stenosis (AS) and regurgitation (AR), are scarce. Therefore, this study investigated the impact of BNP on the clinical outcomes in such patients. Methods and results Clinical data from 81 patients (mean age, 74.1 ± 6.8 years; 50.6%, men) treated for moderate MAVD and left ventricular ejection fraction (LVEF) ≥ 50% during 2010–2018 were retrospectively analysed. Specific echocardiographic data of the study patients were LVEF of 57.8 ± 5.0%, aortic valve index of 0.64 ± 0.04 cm2/m2, peak aortic valve velocity of 3.38 ± 0.29 m/s, and AR vena contracta width of 4.2 ± 0.7 mm. The median BNP level was 61.4 pg/mL (interquartile range, 29.7–109.9). The primary endpoint was a composite of all‐cause death, heart failure hospitalization, and aortic valve replacement, and its cumulative incidence at 5 years was 57.7%. Multivariable analysis revealed that age (hazard ratio, 1.079; 95% confidence interval, 1.028–1.133; P = 0.002) and BNP levels (hazard ratio, 1.028; 95% confidence interval, 1.003–1.053; P = 0.027) were significantly related to the endpoint; specifically, BNP > 61.4 pg/mL had significantly higher incidence rates of the endpoint than those with a BNP ≤ 61.4 pg/mL (70.3% vs. 45.5% at 5 years; P = 0.018). Compared with patients with BNP ≤ 61.4 pg/mL, those with BNP > 61.4 pg/mL had significantly worse left ventricular global longitudinal strain (−17.1 ± 3.6% vs. −18.7 ± 2.6%; P = 0.029), along with higher left ventricular mass index (116.9 ± 27.8 g/m2 vs. 103.5 ± 19.7 g/m2; P = 0.014), relative wall thickness (0.45 ± 0.07 vs. 0.42 ± 0.05; P = 0.022), left atrial volume index (46.0 ± 28.4 mL/m2 vs. 31.4 ± 10.3 mL/m2; P = 0.003), pulmonary artery systolic pressure (32.6 ± 9.7 mmHg vs. 28.2 ± 4.7 mmHg; P = 0.011), and prevalence of moderate or greater tricuspid regurgitation (15.0% vs. 0.0%; P = 0.012). Conclusions Patients with moderate MAVD are at higher risk of unfavourable clinical outcomes, and age and BNP are independently related to the occurrence of adverse events. High BNP levels may reflect extravalvular cardiac damage in patients with moderate MAVD.

A year in heart failure: updates of clinical and preclinical findings

“…Another potential would be to apply HF evaluation to moderate VHD to predict the disease progression and optimize intervention timing. The latter is supported by a study of 81 patients with moderate and mixed aortic valve disease, in which age and B‐type natriuretic peptide levels were associated with adverse events 28 …”

“…The latter is supported by a study of 81 patients with moderate and mixed aortic valve disease, in which age and B-type natriuretic peptide levels were associated with adverse events. 28 In patients with HFrEF, functional mitral regurgitation (MR) is frequently observed and associated with poor prognosis. A recent meta-analysis of edge-to-edge transcatheter mitral repair revealed a lower mortality of patients with functional MR of non-ischaemic compared with ischaemic origin.…”

Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease

“… 12 14 22 23 Recently, Onishi et al demonstrated in a small MAVD population (ie, 81 patients) that BNP levels are independently associated with the endpoint of all-cause mortality, heart-failure hospitalisation and AVR. 24 Nevertheless, as BNP or Nt-proBNP level increase with age and in women, and their elevation is lower in valvular heart diseases than heart failure, the use of the clinical activation ratio (ie, over the maximal expected value for age, sex and assay) has the advantage to take into account interpatient variability. 25 In this study, median absolute Nt-proBNP value and its ratio were higher than what is observed in isolated AS or isolated AR, reflecting the presence of both volume and pressure overload.…”

B-type natriuretic peptide and N-terminal Pro-B-type natriuretic peptide in severe aortic stenosis: a comprehensive literature review

“…In patients with moderate-to-severe MAVD, high BNP levels were correlated with worse LV-GLS, higher LV-mass index, elevated left atrial volume index, and higher prevalence of moderate or greater tricuspid regurgitation, which are significantly associated with critical clinical outcomes. Previous studies demonstrated worse outcomes in patients with moderate MAVD when compared to those with either moderate AS or AR alone ( 25 ).…”