Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis.
BACKGROUND
The prognostic value of natriuretic peptides in aortic stenosis (AS) remains unknown.


RESULTS
B-type natriuretic peptide (BNP), N-terminal BNP (NtBNP), and N-terminal atrial natriuretic peptide (NtANP) were determined in 130 patients with severe AS (mean age, 70+/-12 years; mean gradient, 64+/-21 mm Hg; valve area, 0.64+/-0.15 cm2) who were followed up for 377+/-150 days. Natriuretic peptides increased with NYHA class and with decreasing ejection fraction (EF). Even asymptomatic patients frequently had elevated neurohormones. Asymptomatic patients who developed symptoms during follow-up had higher BNP and NtBNP levels at entry compared with those remaining asymptomatic (median for NtBNP, 131 pmol/L [interquartile range, 50 to 202 pmol/L] versus 31 pmol/L [range, 19 to 56 pmol/L]; P<0.001). Symptom-free survival at 3, 6, 9, and 12 months for patients with NtBNP <80 versus > or =80 pmol/L was 100%, 88+/-7%, 88+/-7%, and 69+/-13% compared with 92+/-8%, 58+/-14%, 35+/-15%, and 18+/-15%, respectively (P<0.001). Seventy-nine patients eventually underwent surgery because of symptoms. Considering preoperative neurohormone levels, age, NYHA class, aortic valve area, EF, and presence of coronary artery disease, we found that neurohormones, EF, and NYHA class predicted survival; neurohormones predicted postoperative symptomatic status; and neurohormones and preoperative EF predicted postoperative EF. However, by multivariate analysis, NtBNP was the only independent predictor of outcome.


CONCLUSIONS
In severe AS, natriuretic peptides provide important prognostic information beyond clinical and echocardiographic evaluation. NtBNP independently predicts symptom-free survival, and preoperative NtBNP independently predicts postoperative outcome with regard to survival, symptomatic status, and left ventricular function. Thus, neurohormones may gain particular importance for timing of surgery in asymptomatic severe AS.
Bergler-Klein
Jutta
J
Department of Cardiology and the Ludwig Boltzmann Institute of Cardiovascular Research, University of Vienna, Vienna, Austria.
Klaar
Ursula
U
Heger
Maria
M
Rosenhek
Raphael
R
Mundigler
Gerald
G
Gabriel
Harald
H
Binder
Thomas
T
Pacher
Richard
R
Maurer
Gerald
G
Baumgartner
Helmut
H
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers; D018450:Disease Progression; D018572:Disease-Free Survival; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009419:Nerve Tissue Proteins / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography
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