Association of B-Type Natriuretic Peptide With Survival in Patients With Degenerative Mitral Regurgitation

Marie Annick Clavel, Christophe Tribouilloy, Jean Louis Vanoverschelde, Rodolfo Pizarro, Rakesh M. Suri, Catherine Szymanski, Siham Lazam, Pablo Oberti, Hector I Michelena, Allan S Jaffe, Maurice E Sarano

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Studies suggesting that B-type natriuretic peptide (BNP) may predict outcomes of mitral regurgitation (MR) are plagued by small size, inconsistent etiologies, and lack of accounting for shifting normal BNP ranges with age and sex. Objectives This study assessed the effect of BNP activation on mortality in a large, multicenter cohort of patients with degenerative MR. Methods In 1,331 patients with degenerative MR, BNP was prospectively measured at diagnosis and expressed as BNPratio (ratio to upper limit of normal for age, sex, and assay). Initial surgical management was performed within 3 months of diagnosis in 561 patents. Results The cohort had a mean age of 64 ± 15 years, was 66% male, and had a mean ejection fraction 64 ± 9%, mean regurgitant volume 67 ± 31 ml, and low mean Charlson comorbidity index of 1.09 ± 1.76. Median BNPratio was 1.01 (25th and 75th percentiles: 0.42 to 2.36). Overall, BNPratio was a powerful, independent predictor of mortality (hazard ratio: 1.33 [95% confidence interval: 1.15 to 1.54]; p < 0.0001), whereas absolute BNP was not (p = 0.43). In patients who were initially treated medically (n = 770; 58%), BNPratio was a powerful, independent, and incremental predictor of mortality after diagnosis (hazard ratio: 1.61 [95% confidence interval: 1.34 to 1.93]; p < 0.0001). Higher BNP activation was associated with higher mortality (p < 0.0001). All subgroups, particularly severe MR, incurred similar excess mortality with BNP activation. After initial surgical treatment (n = 561, 42%) BNP activation did not impose excess long-term mortality (p = 0.23). Conclusions In patients with degenerative MR, BNPratio is a powerful, independent, and incremental predictor of long-term mortality under medical management. BNPratio should be incorporated into the routine clinical assessment of patients with degenerative MR.

Original languageEnglish (US)
Pages (from-to)1297-1307
Number of pages11
JournalJournal of the American College of Cardiology
Volume68
Issue number12
DOIs
StatePublished - Sep 20 2016

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Brain Natriuretic Peptide
Mitral Valve Insufficiency
Survival
Mortality
Confidence Intervals
Patents
Comorbidity

Keywords

  • brain natriuretic peptide
  • degenerative mitral regurgitation
  • Doppler echocardiography
  • survival
  • valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of B-Type Natriuretic Peptide With Survival in Patients With Degenerative Mitral Regurgitation. / Clavel, Marie Annick; Tribouilloy, Christophe; Vanoverschelde, Jean Louis; Pizarro, Rodolfo; Suri, Rakesh M.; Szymanski, Catherine; Lazam, Siham; Oberti, Pablo; Michelena, Hector I; Jaffe, Allan S; Sarano, Maurice E.

In: Journal of the American College of Cardiology, Vol. 68, No. 12, 20.09.2016, p. 1297-1307.

Research output: Contribution to journalArticle

Clavel, Marie Annick ; Tribouilloy, Christophe ; Vanoverschelde, Jean Louis ; Pizarro, Rodolfo ; Suri, Rakesh M. ; Szymanski, Catherine ; Lazam, Siham ; Oberti, Pablo ; Michelena, Hector I ; Jaffe, Allan S ; Sarano, Maurice E. / Association of B-Type Natriuretic Peptide With Survival in Patients With Degenerative Mitral Regurgitation. In: Journal of the American College of Cardiology. 2016 ; Vol. 68, No. 12. pp. 1297-1307.
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title = "Association of B-Type Natriuretic Peptide With Survival in Patients With Degenerative Mitral Regurgitation",
abstract = "Background Studies suggesting that B-type natriuretic peptide (BNP) may predict outcomes of mitral regurgitation (MR) are plagued by small size, inconsistent etiologies, and lack of accounting for shifting normal BNP ranges with age and sex. Objectives This study assessed the effect of BNP activation on mortality in a large, multicenter cohort of patients with degenerative MR. Methods In 1,331 patients with degenerative MR, BNP was prospectively measured at diagnosis and expressed as BNPratio (ratio to upper limit of normal for age, sex, and assay). Initial surgical management was performed within 3 months of diagnosis in 561 patents. Results The cohort had a mean age of 64 ± 15 years, was 66{\%} male, and had a mean ejection fraction 64 ± 9{\%}, mean regurgitant volume 67 ± 31 ml, and low mean Charlson comorbidity index of 1.09 ± 1.76. Median BNPratio was 1.01 (25th and 75th percentiles: 0.42 to 2.36). Overall, BNPratio was a powerful, independent predictor of mortality (hazard ratio: 1.33 [95{\%} confidence interval: 1.15 to 1.54]; p < 0.0001), whereas absolute BNP was not (p = 0.43). In patients who were initially treated medically (n = 770; 58{\%}), BNPratio was a powerful, independent, and incremental predictor of mortality after diagnosis (hazard ratio: 1.61 [95{\%} confidence interval: 1.34 to 1.93]; p < 0.0001). Higher BNP activation was associated with higher mortality (p < 0.0001). All subgroups, particularly severe MR, incurred similar excess mortality with BNP activation. After initial surgical treatment (n = 561, 42{\%}) BNP activation did not impose excess long-term mortality (p = 0.23). Conclusions In patients with degenerative MR, BNPratio is a powerful, independent, and incremental predictor of long-term mortality under medical management. BNPratio should be incorporated into the routine clinical assessment of patients with degenerative MR.",
keywords = "brain natriuretic peptide, degenerative mitral regurgitation, Doppler echocardiography, survival, valvular heart disease",
author = "Clavel, {Marie Annick} and Christophe Tribouilloy and Vanoverschelde, {Jean Louis} and Rodolfo Pizarro and Suri, {Rakesh M.} and Catherine Szymanski and Siham Lazam and Pablo Oberti and Michelena, {Hector I} and Jaffe, {Allan S} and Sarano, {Maurice E}",
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T1 - Association of B-Type Natriuretic Peptide With Survival in Patients With Degenerative Mitral Regurgitation

AU - Clavel, Marie Annick

AU - Tribouilloy, Christophe

AU - Vanoverschelde, Jean Louis

AU - Pizarro, Rodolfo

AU - Suri, Rakesh M.

AU - Szymanski, Catherine

AU - Lazam, Siham

AU - Oberti, Pablo

AU - Michelena, Hector I

AU - Jaffe, Allan S

AU - Sarano, Maurice E

PY - 2016/9/20

Y1 - 2016/9/20

N2 - Background Studies suggesting that B-type natriuretic peptide (BNP) may predict outcomes of mitral regurgitation (MR) are plagued by small size, inconsistent etiologies, and lack of accounting for shifting normal BNP ranges with age and sex. Objectives This study assessed the effect of BNP activation on mortality in a large, multicenter cohort of patients with degenerative MR. Methods In 1,331 patients with degenerative MR, BNP was prospectively measured at diagnosis and expressed as BNPratio (ratio to upper limit of normal for age, sex, and assay). Initial surgical management was performed within 3 months of diagnosis in 561 patents. Results The cohort had a mean age of 64 ± 15 years, was 66% male, and had a mean ejection fraction 64 ± 9%, mean regurgitant volume 67 ± 31 ml, and low mean Charlson comorbidity index of 1.09 ± 1.76. Median BNPratio was 1.01 (25th and 75th percentiles: 0.42 to 2.36). Overall, BNPratio was a powerful, independent predictor of mortality (hazard ratio: 1.33 [95% confidence interval: 1.15 to 1.54]; p < 0.0001), whereas absolute BNP was not (p = 0.43). In patients who were initially treated medically (n = 770; 58%), BNPratio was a powerful, independent, and incremental predictor of mortality after diagnosis (hazard ratio: 1.61 [95% confidence interval: 1.34 to 1.93]; p < 0.0001). Higher BNP activation was associated with higher mortality (p < 0.0001). All subgroups, particularly severe MR, incurred similar excess mortality with BNP activation. After initial surgical treatment (n = 561, 42%) BNP activation did not impose excess long-term mortality (p = 0.23). Conclusions In patients with degenerative MR, BNPratio is a powerful, independent, and incremental predictor of long-term mortality under medical management. BNPratio should be incorporated into the routine clinical assessment of patients with degenerative MR.

AB - Background Studies suggesting that B-type natriuretic peptide (BNP) may predict outcomes of mitral regurgitation (MR) are plagued by small size, inconsistent etiologies, and lack of accounting for shifting normal BNP ranges with age and sex. Objectives This study assessed the effect of BNP activation on mortality in a large, multicenter cohort of patients with degenerative MR. Methods In 1,331 patients with degenerative MR, BNP was prospectively measured at diagnosis and expressed as BNPratio (ratio to upper limit of normal for age, sex, and assay). Initial surgical management was performed within 3 months of diagnosis in 561 patents. Results The cohort had a mean age of 64 ± 15 years, was 66% male, and had a mean ejection fraction 64 ± 9%, mean regurgitant volume 67 ± 31 ml, and low mean Charlson comorbidity index of 1.09 ± 1.76. Median BNPratio was 1.01 (25th and 75th percentiles: 0.42 to 2.36). Overall, BNPratio was a powerful, independent predictor of mortality (hazard ratio: 1.33 [95% confidence interval: 1.15 to 1.54]; p < 0.0001), whereas absolute BNP was not (p = 0.43). In patients who were initially treated medically (n = 770; 58%), BNPratio was a powerful, independent, and incremental predictor of mortality after diagnosis (hazard ratio: 1.61 [95% confidence interval: 1.34 to 1.93]; p < 0.0001). Higher BNP activation was associated with higher mortality (p < 0.0001). All subgroups, particularly severe MR, incurred similar excess mortality with BNP activation. After initial surgical treatment (n = 561, 42%) BNP activation did not impose excess long-term mortality (p = 0.23). Conclusions In patients with degenerative MR, BNPratio is a powerful, independent, and incremental predictor of long-term mortality under medical management. BNPratio should be incorporated into the routine clinical assessment of patients with degenerative MR.

KW - brain natriuretic peptide

KW - degenerative mitral regurgitation

KW - Doppler echocardiography

KW - survival

KW - valvular heart disease

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