Accès ouvert déclaré 2021 dataset

Usefulness of the B-Type Natriuretic Peptides in Low Ejection Fraction, Low-Flow, Low-Gradient Aortic Stenosis Results from the TOPAS Multicenter Prospective Cohort Study

Mohamed‐Salah Annabi, Bin Zhang, Jutta Bergler‐Klein, Abdellaziz Dahou, Ian G. Burwash, Ezéquiel Guzzetti, Géraldine Ong, Lionel Tastet, Stefan Orwat, Helmut Baumgartner, Philipp E. Bartko, Matthias Koschutnik, Julia Mascherbauer, Gerald Mundigler, João L. Cavalcante, Henrique Barbosa Ribeiro, Josep Rodés‐Cabau, Philippe Pîbarot, Marie‐Annick Clavel

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Background: Patients with low left ventricular ejection fraction (LVEF), low-flow, low-gradient (i.e. classical low flow [CLF]) aortic stenosis (AS) have a dismal short-term outcome without aortic valve replacement (AVR) but high operative mortality. We hypothesized that brain natriuretic peptides (BNP/NT-proBNP) can risk stratify patients with CLF AS and may assist in clinical decision-making. Methods: Patients with aortic valve area ≤1.2 cm2, mean transvalvular gradient <40 mmHg, and left ventricular ejection fraction <50%, were prospectively recruited. BNP and/or NT-proBNP were measured at baseline. Results: Among 234 patients (77 [68–83] years, 76% male), BNP > 550 pg/ml or NT-proBNP > 1,600 pg/ml (85% and 93% sensitivity, respectively, to correctly classify 1-year death) strongly predicted all-cause mortality (adjusted HR = 2.53 [1.68–3.81], p < 0.001) outperforming flow reserve and baseline LVEF (all likelihood ratio p ≤ 0.02). For both natriuretic peptides, spline curve analysis showed gradual increase in mortality with higher biomarkers levels, which was blunted by AVR. In a head-to-head comparison (n = 104), NT-proBNP appeared to have superior incremental prognostic value than BNP (likelihood-ratio p < 0.001 vs. p = 0.07). Baseline NT-proBNP ≥ 1,600 pg/ml or BNP ≥ 550 pg/ml, identified: i) a high-risk cohort with a dismal outcome under conservative management, but a markedly better survival associated with early AVR (adjusted HR = 0.41 [0.25–0.65], p < 0.001); and ii) a low-risk cohort with an excellent 1-year survival (94 ± 4%) with conservative management or deferred AVR. Conclusion: In patients with CLF AS, BNP/NT-proBNP have the potential to identify high-risk patients who may benefit from early AVR.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.

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Les sujets associés

Cardiac Valve Diseases and TreatmentsCardiac, Anesthesia and Surgical Outcomes

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