title: Factors responsible for elevated plasma B-type natriuretic peptide levels in severe aortic stenosis: comparison between elderly and younger patients.
abstract: BACKGROUND
  Elevated plasma B-type natriuretic peptide (BNP) is a predictor of outcome and helpful for risk stratification in aortic stenosis (AS). However, left ventricular (LV) diastolic dysfunction progresses with aging and may also influence plasma BNP levels in elderly patients. We hypothesized that plasma BNP levels may be influenced by age in severe AS, and that factors that affect the elevation of plasma BNP levels may be different between elderly and younger patients with AS.
  
  
  METHODS
  We performed echocardiography in 341 patients with severe AS [aortic valve area (AVA)<1.0cm(2)] and classified them into two groups by age (elderly ≥75 years old, n=201; younger patients <75 years old, n=140). We used multivariate linear regression analysis to assess the factors that determine plasma BNP levels in both groups.
  
  
  RESULTS
  Age was found to be one of the independent determinants of plasma BNP levels in all patients (β=0.135, p=0.005). Although AVA was similar in the two groups, plasma BNP levels and E/e' were significantly higher in elderly than younger patients [133.0 (IQR, 73.3-329.7)pg/dl vs 92.8 (IQR, 40.6-171.8)pg/dl, p<0.01; 20±8 vs 16±6, p<0.01, respectively). In multivariate stepwise linear regression analysis, AVA index, LV ejection fraction, mass index, E/e', estimated systolic pulmonary artery pressure (eSPAS), and the presence of atrial fibrillation were independent determinants of plasma BNP levels in younger patients. In contrast, the independent determinants of plasma BNP levels in elderly patients were LV ejection fraction, mass index, E/e', eSPAS, the presence of atrial fibrillation, age, and hemoglobin levels, but not AVA index.
  
  
  CONCLUSIONS
  There may be differences in the factors that influence plasma BNP levels between elderly and younger patients with severe AS. In elderly patients, plasma BNP levels may be influenced more by these factors than AS severity compared with younger patients.
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: daimon@muf.biglobe.ne.jp.
authors.forename: Masao
authors.initials: M
authors.lastname: Daimon
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kawata
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Sakiko
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Ichikawa
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Maruyama
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Shuo-Ju
authors.initials: SJ
authors.lastname: Chiang
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Mahara
authors.affiliation: Department of Cardiology, Tokyo Bay Urayasu/Ichikawa Medical Center, Chiba, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Hitonobu
authors.initials: H
authors.lastname: Tomoike
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Aortic stenosis; Cardiac function; Echocardiography; Plasma B-type natriuretic peptide