Prognostic value of NT-proBNP and an adapted monin score in patients with asymptomatic aortic stenosis.
OBJECTIVE
Our objective was to assess the prognostic value of NT-proBNP in patients with asymptomatic moderate/severe aortic stenosis and to validate an adapted Monin score using natriuretic peptide levels in our setting.


METHODS
Prospective study of 237 patients with degenerative asymptomatic moderate/severe aortic stenosis. NT-proBNP was determined in all patients, who were then followed up clinically. The adapted Monin score was defined as follows: (peak velocity [m/s]×2)+(logn NT-proBNP×1.5)(+1.5 if woman). A clinical event was defined as surgery, hospital admission due to angina, heart failure or syncope, or death.


RESULTS
A total of 51% were women, and the mean age was 74 years. Mean (SD) echocardiographic values were as follows: peak velocity 4.14 (0.87) m/s; mean gradient, 43.2 (16.0) mmHg; aortic valve area, 0.87 (0.72) cm(2), and aortic valve area index, 0.49 (0.14) cm(2)/m(2). The median NT-pro-BNP value was 490.0 [198.0-1312.0] pg/mL. There were 153 events during follow-up (median 18 months). The optimum NT-proBNP cut-point was 515 pg/mL, giving event-free survival rates at 1 and 2 years of 93% and 57%, respectively, in patients with NT-proBNP <515 pg/mL compared with 50% and 31% in those with NT-proBNP >515 pg/mL. Patients were divided into quartiles based on the Monin score. Event-free survival at 1 and 2 years was 87% and 79% in the first quartile, compared with 45% and 28% in the fourth quartile, respectively.


CONCLUSIONS
NT-proBNP determination provides prognostic information in patients with asymptomatic moderate/severe aortic stenosis. The adapted Monin score is useful in our setting and allows a more precise prognosis than does the use of NT-proBNP alone.
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Núria
N
Farré
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain. Electronic address: mgomezpe@parcdesalutmar.cat.
Miquel
M
Gómez
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Luis
L
Molina
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Mercedes
M
Cladellas
Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Mireia
M
Blé
Servicio de Geriatría, Centre Fòrum, Parc de Salut Mar, Barcelona, Spain.
Cristina
C
Roqueta
Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Maria Soledad
MS
Ascoeta
Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Josep
J
Comin-Colet
Institut Municipal d'Investigació Mèdica (IMIM), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.
Joan
J
Vila
Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Jordi
J
Bruguera
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
AS; AVR; Aortic valve stenosis; B-type natriuretic peptide; BNP; Echocardiography; Ecocardiografía; Estenosis valvular aórtica; N-terminal pro-B-type natriuretic peptide; NT-proBNP; Natriuretic peptides; Péptidos natriuréticos; Vmax; aortic stenosis; aortic valve replacement; maximum velocity