Natriuretic peptides and long-term mortality in patients with severe aortic stenosis.
OBJECTIVE
The natriuretic peptides, brain natriuretic peptide (BNP) and its N-terminal prohormone (NT-proBNP), can be used as diagnostic and prognostic markers for aortic stenosis (AS). However, the association between BNP, NT-proBNP, and long-term clinical outcomes in patients with severe AS remains uncertain.


METHODS
A total of 64 patients with severe AS was prospectively enrolled into the study, and underwent clinical and echocardiographic assessments at baseline. Blood samples were drawn for plasma BNP and NT-proBNP analyses. The primary outcome was death from any cause, through a six-year follow up period. Cox proportional hazards modeling was used to examine the association between natriuretic peptides and long-term mortality, adjusting for important clinical factors.


RESULTS
During a mean period of 1,520 +/- 681 days, 51 patients (80%) were submitted to aortic valve replacement, and 13 patients (20%) were medically managed without surgical interventions. Mortality rates were 13.7% in the surgical group and 62% in the medically managed group (p < 0.001). Patients with higher plasma BNP (> 135 pg/ml) and NT-proBNP (> 1,150 pg/ml) levels at baseline had a greater risk of long-term mortality (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.1-9.1; HR 4.3, 95% CI 1.4-13.5, respectively). After adjusting for important covariates, both BNP and NT-proBNP remained independently associated with long-term mortality (HR 2.9, 95% CI 1.5-5.7; HR 1.8, 95% CI 1.1-3.1, respectively).


CONCLUSIONS
In patients with severe AS, plasma BNP and NT-proBNP levels were associated with long-term mortality. The use of these biomarkers to guide treatment might represent an interesting approach that deserves further evaluation.
Heart Institute, University of Sao Paulo Medical School, Brazil. mksp1975@gmail.com
Marcelo
M
Katz
Flavio
F
Tarasoutchi
Antonio Eduardo Pereira
AE
Pesaro
Renato D
RD
Lopes
Guilherme Sobreira
GS
Spina
Marcelo Luiz Campos
ML
Vieira
Max
M
Grinberg
D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers; D019468:Disease Management; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010043:Outcome and Process Assessment, Health Care; D010446:Peptide Fragments / Q000378:metabolism*; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate; D017741:Survivors
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain