Combined use of tissue Doppler imaging and natriuretic peptides as prognostic marker in asymptomatic aortic stenosis

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• 作者：Miquel Gomez Perez^a ; ^b ; ^{mgomezpe@parcdesalutmar.cat} ; Mireia Ble^a ; ^b ; Mercedes Cladellas^a ; ^b ; Lluis Molina^a ; ^b ; Joan Vila^a ; Alexandra Mas-Stachurska^a ; Laura Higueras-Ortega^a ; Julio Marti-Almor^a ; ^b
• 关键词：Aortic stenosis ; Tissue Doppler imaging ; Natriuretic peptides
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：890-894
• 全文大小：420 K
• 卷排序：228

文摘

Tissue Doppler imaging (TDI) and N-terminal-pro-Brain Natriuretic Peptide (NT-proBNP) provides useful non-invasive information about left ventricle filling pressures and both have demonstrated to be a prognostic marker in some valve disease as aortic stenosis (AS).ObjectivesTo assess the clinical value of combined TDI and NT-proBNP information in asymptomatic AS patients.Material and methodsProspective study of 350 initially asymptomatic moderate to severe AS patients with: Mean aortic valve area 0.8 (0.3) cm2, mean gradient 45(13) mm Hg, ejection fraction 61 (9) %. Mean age: 74.6 (4.3) years. In all patients were determined NT-proBNP in the serum and TDI parameters the lateral mitral annulus. We considered clinical event the admission in the hospital due to symptoms related to AS (angina, heart failure or syncope) as well as surgical treatment or mortality.ResultsAfter a mean follow-up of 29 (10) months, 165 (47%) patients suffered some clinical event. In order to predict clinical events, Bootstrap analysis determined the best cut-point value: E/E′ ratio higher than 13 and NT-proBNP higher than 515 pg/mL. E/E′ ratio provides more specificity (78.9% vs 55.9%) and NT-proBNP provides more sensitivity (76.6% vs 43.7%). Combined use of both parameters provides the best prognostic information (sensitivity 75.6%, specificity 67.2%, negative predictive value 82.1%, positive predictive value 57.5%, accuracy 71.4%).ConclusionCombined use of TDI and natriuretic peptides information provides incremental prognostic value and is a useful tool to predict the prognosis in asymptomatic AS patients.