{"title":"老年经导管主动脉瓣置换术患者脑利钠肽n端前体与术后预后的相关性。","authors":"Ying-Ching Huang, Hsiao-Huang Chang, Po-Lin Chen, Chi-Ming Chu, Jen-Chen Tsai, Kwua-Yun Wang","doi":"10.1097/JCMA.0000000000000916","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing transcatheter aortic valve replacement surgery (TAVR) are typically older adults with multiple chronic diseases and therefore have a high surgical risk. The N-terminal of brain natriuretic peptide (BNP) and pro-BNP, referred to as NT-pro-BNP, is an easily measurable biomarker of heart failure. Studies on correlation between higher NT-pro-BNP levels and adverse prognoses after TAVR have yielded inconsistent results. Here, we investigated whether preoperative NT-pro-BNP levels are correlated with outcomes among older adults undergoing TAVR.</p><p><strong>Methods: </strong>This retrospective study included older adults with severe aortic stenosis (AS) who received TAVR from a medical center between January 2013 and June 2017. The patients' demographics, preoperative laboratory data, postoperative complications, and 1-year mortality were recorded. They were divided into two groups based on their preoperative NT-pro-BNP levels. The post-TAVR outcomes in the two groups were analyzed using a multivariate logistic regression analysis of the binary results.</p><p><strong>Results: </strong>Of the 132 patients included (mean age: 81.5 ± 8.1 years; 47% men), 96 (72.7%) had preoperative NT-pro-BNP levels ≤ 4853 ng/L, and 36 (27.3%) had preoperative NT-pro-BNP levels > 4853 ng/L. The postoperative outcomes were significantly better in the NT-pro-BNP≤4853 group than in the NT-pro-BNP>4853 group: postoperative extracorporeal membrane oxygenation fittings (4.2% vs 16.7%, p = 0.025), number of days in hospital (17.5 ± 21.0 vs 27 ± 17.0, p = 0.009), in-hospital mortality (4.2% vs 16.7%, p = 0.025), and 1-year mortality (11.5% vs 38.9%, p = 0.001); the significant differences persisted after controlling for other variables.</p><p><strong>Conclusion: </strong>For older patients undergoing TAVR with NT-pro-BNP levels > 4853 ng/L, their postoperative outcomes and 1-year mortality were correlated. Thus, NT-pro-BNP is useful for the risk assessment of patients undergoing TAVR and should be regarded as a biomarker in future risk assessments.</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":"86 5","pages":"479-484"},"PeriodicalIF":1.9000,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Correlation of N-terminal-pro-brain natriuretic peptide with postoperative outcomes of older patients undergoing transcatheter aortic valve replacement.\",\"authors\":\"Ying-Ching Huang, Hsiao-Huang Chang, Po-Lin Chen, Chi-Ming Chu, Jen-Chen Tsai, Kwua-Yun Wang\",\"doi\":\"10.1097/JCMA.0000000000000916\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients undergoing transcatheter aortic valve replacement surgery (TAVR) are typically older adults with multiple chronic diseases and therefore have a high surgical risk. The N-terminal of brain natriuretic peptide (BNP) and pro-BNP, referred to as NT-pro-BNP, is an easily measurable biomarker of heart failure. Studies on correlation between higher NT-pro-BNP levels and adverse prognoses after TAVR have yielded inconsistent results. Here, we investigated whether preoperative NT-pro-BNP levels are correlated with outcomes among older adults undergoing TAVR.</p><p><strong>Methods: </strong>This retrospective study included older adults with severe aortic stenosis (AS) who received TAVR from a medical center between January 2013 and June 2017. The patients' demographics, preoperative laboratory data, postoperative complications, and 1-year mortality were recorded. They were divided into two groups based on their preoperative NT-pro-BNP levels. The post-TAVR outcomes in the two groups were analyzed using a multivariate logistic regression analysis of the binary results.</p><p><strong>Results: </strong>Of the 132 patients included (mean age: 81.5 ± 8.1 years; 47% men), 96 (72.7%) had preoperative NT-pro-BNP levels ≤ 4853 ng/L, and 36 (27.3%) had preoperative NT-pro-BNP levels > 4853 ng/L. The postoperative outcomes were significantly better in the NT-pro-BNP≤4853 group than in the NT-pro-BNP>4853 group: postoperative extracorporeal membrane oxygenation fittings (4.2% vs 16.7%, p = 0.025), number of days in hospital (17.5 ± 21.0 vs 27 ± 17.0, p = 0.009), in-hospital mortality (4.2% vs 16.7%, p = 0.025), and 1-year mortality (11.5% vs 38.9%, p = 0.001); the significant differences persisted after controlling for other variables.</p><p><strong>Conclusion: </strong>For older patients undergoing TAVR with NT-pro-BNP levels > 4853 ng/L, their postoperative outcomes and 1-year mortality were correlated. Thus, NT-pro-BNP is useful for the risk assessment of patients undergoing TAVR and should be regarded as a biomarker in future risk assessments.</p>\",\"PeriodicalId\":17251,\"journal\":{\"name\":\"Journal of the Chinese Medical Association\",\"volume\":\"86 5\",\"pages\":\"479-484\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2023-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Chinese Medical Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JCMA.0000000000000916\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Chinese Medical Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JCMA.0000000000000916","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
背景:接受经导管主动脉瓣置换术(TAVR)的患者通常是患有多种慢性疾病的老年人，因此手术风险高。脑钠肽(BNP)和前BNP的n端，简称nt -亲BNP，是一种容易测量的心力衰竭生物标志物。关于TAVR后NT-pro-BNP水平升高与不良预后之间相关性的研究得出了不一致的结果。在这里，我们研究了术前NT-pro-BNP水平是否与接受TAVR的老年人的预后相关。方法:本回顾性研究纳入了2013年1月至2017年6月期间在医疗中心接受TAVR治疗的严重主动脉瓣狭窄(AS)老年人。记录患者的人口统计学、术前实验室数据、术后并发症和1年死亡率。根据术前NT-pro-BNP水平将患者分为两组。两组tavr后的结果采用二元结果的多变量logistic回归分析。结果:纳入的132例患者(平均年龄:81.5±8.1岁;47%男性)，96例(72.7%)术前NT-pro-BNP水平≤4853 ng/L, 36例(27.3%)术前NT-pro-BNP水平> 4853 ng/L。NT-pro-BNP≤4853组的术后结局明显优于NT-pro-BNP>4853组:术后体外膜氧合(4.2% vs 16.7%， p = 0.025)、住院天数(17.5±21.0 vs 27±17.0,p = 0.009)、住院死亡率(4.2% vs 16.7%， p = 0.025)和1年死亡率(11.5% vs 38.9%， p = 0.001);在控制了其他变量后，显著差异仍然存在。结论:NT-pro-BNP水平> 4853 ng/L的老年TAVR患者术后预后与1年死亡率相关。因此，NT-pro-BNP对TAVR患者的风险评估是有用的，应被视为未来风险评估的生物标志物。
Correlation of N-terminal-pro-brain natriuretic peptide with postoperative outcomes of older patients undergoing transcatheter aortic valve replacement.
Background: Patients undergoing transcatheter aortic valve replacement surgery (TAVR) are typically older adults with multiple chronic diseases and therefore have a high surgical risk. The N-terminal of brain natriuretic peptide (BNP) and pro-BNP, referred to as NT-pro-BNP, is an easily measurable biomarker of heart failure. Studies on correlation between higher NT-pro-BNP levels and adverse prognoses after TAVR have yielded inconsistent results. Here, we investigated whether preoperative NT-pro-BNP levels are correlated with outcomes among older adults undergoing TAVR.
Methods: This retrospective study included older adults with severe aortic stenosis (AS) who received TAVR from a medical center between January 2013 and June 2017. The patients' demographics, preoperative laboratory data, postoperative complications, and 1-year mortality were recorded. They were divided into two groups based on their preoperative NT-pro-BNP levels. The post-TAVR outcomes in the two groups were analyzed using a multivariate logistic regression analysis of the binary results.
Results: Of the 132 patients included (mean age: 81.5 ± 8.1 years; 47% men), 96 (72.7%) had preoperative NT-pro-BNP levels ≤ 4853 ng/L, and 36 (27.3%) had preoperative NT-pro-BNP levels > 4853 ng/L. The postoperative outcomes were significantly better in the NT-pro-BNP≤4853 group than in the NT-pro-BNP>4853 group: postoperative extracorporeal membrane oxygenation fittings (4.2% vs 16.7%, p = 0.025), number of days in hospital (17.5 ± 21.0 vs 27 ± 17.0, p = 0.009), in-hospital mortality (4.2% vs 16.7%, p = 0.025), and 1-year mortality (11.5% vs 38.9%, p = 0.001); the significant differences persisted after controlling for other variables.
Conclusion: For older patients undergoing TAVR with NT-pro-BNP levels > 4853 ng/L, their postoperative outcomes and 1-year mortality were correlated. Thus, NT-pro-BNP is useful for the risk assessment of patients undergoing TAVR and should be regarded as a biomarker in future risk assessments.
期刊介绍：
Journal of the Chinese Medical Association, previously known as the Chinese Medical Journal (Taipei), has a long history of publishing scientific papers and has continuously made substantial contribution in the understanding and progress of a broad range of biomedical sciences. It is published monthly by Wolters Kluwer Health and indexed in Science Citation Index Expanded (SCIE), MEDLINE®, Index Medicus, EMBASE, CAB Abstracts, Sociedad Iberoamericana de Informacion Cientifica (SIIC) Data Bases, ScienceDirect, Scopus and Global Health.
JCMA is the official and open access journal of the Chinese Medical Association, Taipei, Taiwan, Republic of China and is an international forum for scholarly reports in medicine, surgery, dentistry and basic research in biomedical science. As a vehicle of communication and education among physicians and scientists, the journal is open to the use of diverse methodological approaches. Reports of professional practice will need to demonstrate academic robustness and scientific rigor. Outstanding scholars are invited to give their update reviews on the perspectives of the evidence-based science in the related research field. Article types accepted include review articles, original articles, case reports, brief communications and letters to the editor
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