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首页> 外文期刊>The American Journal of Cardiology >Prognostic Value of Serial B-Type Natriuretic Peptide Measurement in Transcatheter Aortic Valve Replacement (from the PARTNER Trial)
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Prognostic Value of Serial B-Type Natriuretic Peptide Measurement in Transcatheter Aortic Valve Replacement (from the PARTNER Trial)

机译：连续B型利钠肽测量在经导管主动脉瓣置换中的预后价值（来自PARTNER试验）

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摘要

B-type natriuretic peptide (BNP) levels have shown a correlation with outcomes in studies of aortic valve surgery. Results from multicenter trials of BNP in transcatheter aortic valve surgery (TAVR) are lacking. The aim of this study was to investigate the prognostic role of serial measurement of BNP in transfemoral TAVR. A total of 1,097 patients who underwent TAVR via transfemoral access were analyzed by tertile of baseline BNP. Of those, 933 with BNP levels at 30 days were divided into 2 groups on the basis of increases (334 patients) or decreases or no change (599 patients) in BNP compared with baseline. Patients in the low-tertile BNP group had a lower rate of death at 1 year than those in the higher tertile group (15.0% vs 23.0%, p <0.01) which was not significant in multivariate analysis. Over 1 year, BNP decreased from 1,258.13 +/- 2,988.33 to 594.37 +/- 1,087.30 (p <0.01) in the entire group. Patients in the BNP-rise group had higher rates of death at 1 year (20.3% vs 11.4%, p <0.01) and an overall increase in moderate or severe aortic regurgitation over 1 year (p <0.01). Multivariate predictors of 1-year mortality were moderate or severe aortic regurgitation (hazard ratio 2.04,95% confidence interval 1.36 to 3.05, p <0.01), increase in BNP at 30 days (hazard ratio 1.82, 95% confidence interval 1.26 to 2.62, p <0.01) and Society of Thoracic Surgeons score (hazard ratio 1.05, 95% confidence interval 1.01 to 1.10, p = 0.03). In conclusion, increase in BNP at 30 days from baseline and moderate or severe aortic regurgitation at 30 days in patients who undergo transfemoral TAVR are independently associated with 1-year mortality. Increase in BNP at 30 days should prompt evaluation for causes of elevated wall stress, including aortic regurgitation. (C) 2015 Elsevier Inc. All rights reserved.
机译：在主动脉瓣手术研究中，B型利钠肽（BNP）水平与预后相关。缺乏BNP在经导管主动脉瓣手术（TAVR）中进行的多中心试验的结果。这项研究的目的是调查BNP的串行测量在经股TAVR中的预后作用。通过基线BNP的三分位数分析了总共1,097例经股动脉入路接受TAVR的患者。在这些患者中，根据基线时BNP升高（334例）或BNP降低或无变化（599例），将933名BNP水平在30天的患者分为两组。低三分位数BNP组的患者1年死亡率比高三分位数组的患者低（15.0％vs 23.0％，p <0.01），在多变量分析中无统计学意义。超过一年，整个组的BNP从1,258.13 +/- 2,988.33降至594.37 +/- 1,087.30（p <0.01）。 BNP升高组的患者在1年时死亡率较高（20.3％对11.4％，p <0.01），并且在1年中中度或重度主动脉瓣反流总体增加（p <0.01）。 1年死亡率的多因素预测指标是中度或重度主动脉瓣关闭不全（危险比2.04,95％置信区间1.36至3.05，p <0.01），30天BNP升高（危险比1.82、95％置信区间1.26至2.62， p <0.01）和胸外科医师协会评分（危险比1.05，95％置信区间1.01至1.10，p = 0.03）。总之，经股动脉TAVR的患者距基线30天的BNP升高和30天的中度或重度主动脉反流与1年死亡率独立相关。 30天时BNP升高应及时评估壁压力升高的原因，包括主动脉反流。 （C）2015 Elsevier Inc.保留所有权利。

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