Natriuretic peptides in patients with aortic stenosis.
BACKGROUND
Whereas atrial natriuretic peptide (ANP) is secreted mainly from cardiac atria, brain natriuretic peptide (BNP) is produced to a larger extent in ventricles. Their relative importance as markers of cardiac function and myocardial hypertrophy is not yet clarified. This study evaluated circulating BNP and ANP and the N-terminal part of their propeptides (NT-proBNP and NT-proANP) as markers of left ventricular hypertrophy and atrial pressure increase in patients with aortic stenosis.


METHODS
The plasma concentrations of BNP, NT-proBNP, ANP, and NT-proANP were measured by radioimmunoassay in 67 patients with aortic stenosis. Peptide plasma concentrations were related to measurements obtained by cardiac catheterization and echocardiography.


RESULTS
Receiver operating characteristic curves indicated that BNP and NT-proBNP performed best in the detection of increased left ventricular mass and NT-proANP in the detection of increased left atrial pressure. NT-proBNP was significantly increased in mild left ventricular hypertrophy (left ventricular mass index, 78 to 139 g/m(2)), whereas NT-proANP was not increased until left ventricular mass index was 141 to 180 g/m(2).


CONCLUSIONS
Plasma BNP and NT-proBNP may serve as early markers of left ventricular hypertrophy, whereas ANP and NT-proANP reflect left atrial pressure increase. The repeated and combined measurements of natriuretic peptides might provide diagnostic information relevant to the evaluation of the stage of aortic stenosis.
Qi
W
W
Research Institute for Internal Medicine, the National Hospital, the University of Oslo, Norway. christian.hall@klinmed.uio.no
Mathisen
P
P
Kjekshus
J
J
Simonsen
S
S
Bjørnerheim
R
R
Endresen
K
K
Hall
C
C
D000328:Adult; D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood / Q000175:diagnosis*; D016279:Atrial Function, Left / Q000502:physiology; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009419:Nerve Tissue Proteins / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve
D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor