title: Recovery after balloon aortic valvuloplasty in patients with aortic stenosis and impaired left ventricular function: predictors and prognostic implications.
abstract: OBJECTIVE
  The aim of this study was to evaluate predictors of recovery after balloon aortic valvuloplasty (BAV) among patients with aortic stenosis and depressed left ventricular ejection fraction (LVEF). Predictors for recovery after BAV are not clearly defined. B-type natriuretic peptide (BNP) predicts outcome after surgical and transcatheter aortic valve replacement.
  
  
  RESULTS
  Among 151 consecutive patients treated in our institution by BAV, a total of 59 with poor LVEF underwent an echocardiography at 1 month. In these 59 patients, LVEF significantly improved in 22 patients (group 1) from 27 ± 5% to 45 ± 6% (P<.0001) and remained unchanged in 37 patients (group 2) from 29 ± 8% to 30 ± 11% (P=NS). BNP plasma levels at 24 hours only decreased in group 1 from 2170 ± 967 pg/mL to 1208 ± 662 pg/mL (P=.001). By multivariate analysis, BNP reduction >300 pg/mL was the strongest independent predictor of LVEF improvement at 30 days (hazard ratio, 5.459; 95% confidence interval, 1.580-18.860; P=.007). Kaplan-Meier analysis showed that 1-year survival after BAV was significantly higher in patients of group 1 than in group 2 (95 ± 4% vs 51 ± 8%, respectively; P=.02).
  
  
  CONCLUSIONS
  BAV in patients with poor left ventricular function resulted in LVEF improvement at 30 days in 37% of cases, which was detected by a reduction of BNP levels already seen at 24 hours. Survival at 1 year was significantly higher in patients with such an improved LVEF after BAV.
authors: Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. joelle.kefer@uclouvain.be
authors: Joelle
authors: J
authors: Kefer
authors: Jean-Marie
authors: JM
authors: Gapira
authors: Sophie
authors: S
authors: Pierard
authors: Christophe
authors: C
authors: De Meester
authors: Olivier
authors: O
authors: Gurne
authors: Patrick
authors: P
authors: Chenu
authors: Jean
authors: J
authors: Renkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain