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Abstract   Aims  Data on B‐type natriuretic peptide (BNP) levels and adverse outcomes in patients with moderate mixed aortic valve disease (MAVD), defined as moderate aortic stenosis (AS) and regurgitation (AR), are scarce. Therefore, this study investigated the impact of BNP on the clinical outcomes in such patients.    Methods and results  Clinical data from 81 patients (mean age, 74.1 ± 6.8 years; 50.6%, men) treated for moderate MAVD and left ventricular ejection fraction (LVEF) ≥ 50% during 2010–2018 were retrospectively analysed. Specific echocardiographic data of the study patients were LVEF of 57.8 ± 5.0%, aortic valve index of 0.64 ± 0.04 cm 2 /m 2 , peak aortic valve velocity of 3.38 ± 0.29 m/s, and AR vena contracta width of 4.2 ± 0.7 mm. The median BNP level was 61.4 pg/mL (interquartile range, 29.7–109.9). The primary endpoint was a composite of all‐cause death, heart failure hospitalization, and aortic valve replacement, and its cumulative incidence at 5 years was 57.7%. Multivariable analysis revealed that age (hazard ratio, 1.079; 95% confidence interval, 1.028–1.133;  P  = 0.002) and BNP levels (hazard ratio, 1.028; 95% confidence interval, 1.003–1.053;  P  = 0.027) were significantly related to the endpoint; specifically, BNP &gt; 61.4 pg/mL had significantly higher incidence rates of the endpoint than those with a BNP ≤ 61.4 pg/mL (70.3% vs. 45.5% at 5 years;  P  = 0.018). Compared with patients with BNP ≤ 61.4 pg/mL, those with BNP &gt; 61.4 pg/mL had significantly worse left ventricular global longitudinal strain (−17.1 ± 3.6% vs. −18.7 ± 2.6%;  P  = 0.029), along with higher left ventricular mass index (116.9 ± 27.8 g/m 2  vs. 103.5 ± 19.7 g/m 2 ;  P  = 0.014), relative wall thickness (0.45 ± 0.07 vs. 0.42 ± 0.05;  P  = 0.022), left atrial volume index (46.0 ± 28.4 mL/m 2  vs. 31.4 ± 10.3 mL/m 2 ;  P  = 0.003), pulmonary artery systolic pressure (32.6 ± 9.7 mmHg vs. 28.2 ± 4.7 mmHg;  P  = 0.011), and prevalence of moderate or greater tricuspid regurgitation (15.0% vs. 0.0%;  P  = 0.012).    Conclusions  Patients with moderate MAVD are at higher risk of unfavourable clinical outcomes, and age and BNP are independently related to the occurrence of adverse events. High BNP levels may reflect extravalvular cardiac damage in patients with moderate MAVD.

Prognostic relevance of B‐type natriuretic peptide in patients with moderate mixed aortic valve disease