Abstract 18276: Frailty and NT-proBNP Stratify Elderly Patients with Symptomatic Severe Aortic Stenosis
OBJECTIVES: To analyse the additive potential of frailty and NT-proBNP to predict adverse outcome in elderly patients with symptomatic severe aortic stenosis (SAS).
METHODS: Prospective study of outpatients older than 74 years diagnosed of symptomatic SAS. Frailty measures included gait speed in a 15 feet distance, grip strength, weakness, weight loss and physical activity using the Physical Activity Surveillance for the elderly (PASE) questionnaire. Patients were classified as frail when they fulfilled three or more of the five criteria. NTproBNP was measured on first assessment in a stable clinical condition. A cut point of 1000 pg/ml was chosen. Along follow-up, 175 (50.8%) patients received medical-conservative treatment, 46 (13.4%) TAVR, and 123 (35.8%) surgical treatment. Analysis are stratified by performed treatment.
RESULTS: We included 344 patients with fully frailty assessment and one-year follow-up. Mean age was 83, 60.8% were women. Frailty criteria were fulfilled by 156 patients (45.3%) and 201 patients (58.4%) showed a NT-proBNP basal level >1000 pg/ml. Frailty and NT-proBNP basal levels showed statistically significant relationship with mortality and frail patients showed significant higher levels of NT-proBNP. Frail patients showed a one-year mortality of 30.8% vs 9% of non-frail patients (p<0.001). Patients with NTproBNP basal levels ≥1000 pg/ml showed a one-year mortality of 26.9% vs 7.7% of patients with NT-proBNP basal level <1000 pg/ml (p<0.001). When patients were not frail and showed low levels of NT-proBNP, one-year mortality was 3.3% but, when patients fulfilled both, mortality was 38.1%. Frail patients with low level of NT-proBNP and non-frail patients with high levels of NT-proBNP showed intermediate one-year mortality of 15.7% and 14.6% respectively. In multivariate analysis, stratified by treatment and adjusted by age and sex, and taking non-frail-low NTproBNP as reference group, the HR were: frail-low NTproBNP 4.1 (95% CI 1,1-15,6), non-frail-high NTproBNP 4,6 (95% CI 1,3-15,6), frail-high NTproBNP 9,7 (95% CI 2.9-32.0).
CONCLUSIONS: Frailty state and basal NT-proBNP are operative variables to stratify elderly patients with SAS. Using both variables increases the patient prognostic classification power.
Author Disclosures: C. Rodriguez-Pascual: None. T. Parajes: None. M. Castro-Verdes: None. M. Sanmartin: None. E. Gonzalez-Babarro: None. D. Duran: None. J. Baz: None. M. Torrente: None. A. Ferrero: None. E. Paredes: None.
- © 2014 by American Heart Association, Inc.