Higher NT-proBNP ratio was independently associated with 1-year mortality in elderly patients with valvular heart disease (adjusted HR 1.99; 95% CI 1.76-2.24; p<0.001).
Cohort (n=5,983)
Does elevated NT-proBNP ratio predict 1-year mortality in elderly patients with moderate or severe valvular heart disease?
Elevated NT-proBNP ratio provides incremental prognostic value for 1-year mortality across various moderate or severe valvular heart diseases in elderly patients.
Effect estimate: adjusted HR 1.99 (95% CI 1.76-2.24)
p-value: p=<0.001
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) may reflect early prognosis in patients with valvular heart disease (VHD). OBJECTIVES The aim of this study was to examine the association between NT-proBNP and mortality in elderly patients with VHD. METHODS 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. RESULTS 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. CONCLUSIONS 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.
“NT-proBNP ratio is a reliable and incremental prognostic factor in various subtypes of VHD. It can potentially assist risk stratification and decision making as a pragmatic and versatile biomarker in elderly patients [with VHDs].”
Zhang et al. (Wed,) conducted a cohort in Moderate or severe valvular heart disease (n=5,983). Higher NT-proBNP ratio vs. Lower NT-proBNP ratio was evaluated on Mortality (adjusted HR 1.99, 95% CI 1.76-2.24, p=<0.001). Higher NT-proBNP ratio was independently associated with 1-year mortality in elderly patients with valvular heart disease (adjusted HR 1.99; 95% CI 1.76-2.24; p<0.001).