title: Prospective validation of the prognostic usefulness of B-type natriuretic peptide in asymptomatic patients with chronic severe aortic regurgitation.
abstract: OBJECTIVE
  The purpose of this study was to determine the independent and additive prognostic value of B-type natriuretic peptide (BNP) in patients with severe asymptomatic aortic regurgitation and normal left ventricular function.
  
  
  BACKGROUND
  Early surgery could be advisable in selected patients with chronic severe aortic regurgitation, but there are no uniform criteria to identify candidates who could benefit from this strategy. Assessment of BNP has not been studied for this purpose.
  
  
  METHODS
  We prospectively evaluated 294 consecutive patients with severe asymptomatic organic aortic regurgitation and left ventricular ejection fraction above 55%. The first 160 consecutive patients served as the derivation cohort and the next 134 patients served as a validation cohort. The combined endpoint was the occurrence of symptoms of congestive heart failure, left ventricular dysfunction, or death at follow-up.
  
  
  RESULTS
  The endpoint was reached in 45 patients (28%) of the derivation set and in 35 patients (26%) of the validation cohort. Receiver-operator characteristic curve analysis yielded an optimal cutoff point of 130 pg/ml for BNP that was able to discriminate between patients at higher risk in both cohorts. BNP was the strongest independent predictor by multivariate analysis in the derivation set (odds ratio: 6.9 [95% confidence interval: 2.52 to 17.57], p < 0.0001) and the validation set (odds ratio: 6.7 [95% confidence interval: 2.9 to 16.9], p = 0.0001).
  
  
  CONCLUSIONS
  Among patients with severe asymptomatic aortic regurgitation and normal left ventricular function, BNP ≥130 pg/ml categorizes a subgroup of patients at higher risk. Because of its incremental prognostic value, we believe BNP assessment should be used in the routine clinical evaluation of these patients.
authors: Cardiology Division, Hospital Italiano de Buenos Aires, 4190 Juan D. Perón Street, 1181 Buenos Aires, Argentina. rodolfo.pizarro@hospitalitaliano.org.ar
authors: Rodolfo
authors: R
authors: Pizarro
authors: Oscar O
authors: OO
authors: Bazzino
authors: Pablo F
authors: PF
authors: Oberti
authors: Mariano L
authors: ML
authors: Falconi
authors: Aníbal M
authors: AM
authors: Arias
authors: Juan G
authors: JG
authors: Krauss
authors: Arturo M
authors: AM
authors: Cagide
mesh_terms: D001022:Aortic Valve Insufficiency / Q000097:blood* / Q000175:diagnosis*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis
chemical_list: D020097:Natriuretic Peptide, Brain