title: Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis.
abstract: BACKGROUND
  The onset of symptoms is a critical point in the natural history of aortic stenosis and the cardinal indication for valve replacement. This study assessed the associations between natriuretic peptide levels, disease severity, and cardiac symptoms in aortic stenosis.
  
  
  RESULTS
  Seventy-four patients with isolated aortic stenosis underwent independent assessment of symptoms, transthoracic echocardiography, and measurement of plasma levels of atrial natriuretic peptide, brain natriuretic peptide (BNP), and N-BNP. Natriuretic peptide levels were also measured in 100 clinically normal control subjects. The aortic valve area was smaller in symptomatic patients (n=45) than in asymptomatic patients (n=29; mean, 0.71+/-0.23 cm2 and 0.99+/-0.31 cm2, respectively; P<0.0001). Plasma natriuretic peptide levels were higher in symptomatic patients than in asymptomatic patients (for N-BNP: median, 112 versus 33 pmol/L; interquartile range, 70 to 193 versus 16 to 58 pmol/L, respectively; P=0.0002). After adjustment for age, sex, serum creatinine, aortic valve area, and left ventricular ejection fraction, N-BNP levels were 1.74 times higher (95% confidence interval, 1.12 to 2.69) for symptomatic than asymptomatic patients with aortic stenosis (P=0.014). Natriuretic peptide levels increased with the New York Heart Association class (for N-BNP median values were 13, 34, 105, and 202 pmol/L for normal control subjects, class I, class II, and class III/IV patients, respectively; interquartile ranges for the same patients were 8 to 21, 16 to 58, 57 to 159, and 87 to 394 pmol/L; P<0.0001). Similar associations were observed for BNP and atrial natriuretic peptide.
  
  
  CONCLUSIONS
  Plasma natriuretic peptide levels are elevated in symptomatic patients with aortic stenosis. Measurement of natriuretic peptides may complement clinical and echocardiographic evaluation of patients with aortic stenosis.
authors.affiliation: Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
authors.forename: Ivor L
authors.initials: IL
authors.lastname: Gerber
authors.forename: Ralph A H
authors.initials: RA
authors.lastname: Stewart
authors.forename: Malcolm E
authors.initials: ME
authors.lastname: Legget
authors.forename: Teena M
authors.initials: TM
authors.lastname: West
authors.forename: Renelle L
authors.initials: RL
authors.lastname: French
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Sutton
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Yandle
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
mesh_terms: D000367:Age Factors; D000787:Angina Pectoris / Q000097:blood; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009320:Atrial Natriuretic Factor / Q000097:blood*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009419:Nerve Tissue Proteins / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013575:Syncope / Q000097:blood
chemical_list: D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor