title: Impact of Serial B-Type Natriuretic Peptide Changes for Predicting Outcome in Asymptomatic Patients With Aortic Stenosis.
abstract: BACKGROUND
  The aim of this study was to determine the impact on the outcome of serial B-type natriuretic peptide (BNP) changes during follow-up in asymptomatic patients with ≥ moderate aortic stenosis (AS) and preserved left ventricular ejection fraction.
  
  
  METHODS
  We prospectively screened 69 patients who underwent comprehensive transthoracic echocardiography, BNP level measurement at baseline and after every 6 or 12 months. Annualized BNP changes were calculated as the difference between the last and baseline BNP measurements divided by the duration of follow-up. The primary endpoint was the occurrence of symptoms, aortic valve replacement, or cardiovascular death.
  
  
  RESULTS
  During a follow-up of 30 ± 19 months, 43 patients experienced a cardiac event. These patients were significantly older (73 ± 9 vs 65 ± 16 years; P = 0.010), had more often dyslipidemia (79% vs 42%; P = 0.038), more severe AS (peak velocity: 3.9 ± 0.6 vs 3.5 ± 0.6 m/s; P = 0.002), larger indexed left atrial area (10.2 ± 2.5 vs 8.7 ± 1.9 cm(2)/m(2); P = 0.006), and a higher increase in annualized BNP (+90 ± 155 vs +7 ± 49 pg/mL/y; P = 0.010). Patients with higher annualized BNP changes (> 20 pg/mL/y) had a significantly lower cardiac event-free survival (1 year: 63 ± 8% vs 97 ± 3%; 3 years: 31 ± 8% vs 68 ± 8%; P < 0.001). Using the multivariate Cox proportional hazards model, higher annualized BNP changes were significantly associated with increased risk of cardiac events (hazard ratio: 2.73, 95% confidence interval: 1.27-5.86; P = 0.010) after adjustment for age, dyslipidemia, and echocardiographic parameters.
  
  
  CONCLUSIONS
  In asymptomatic patients with AS and preserved left ventricular ejection fraction, the use of serial BNP changes may help to anticipate development of class I indication for aortic valve replacement.
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium; Division of Non Invasive Cardiology, Department of Medicine, University of Montreal, Montreal Heart Institute, Montréal, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Henri
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
authors.forename: Raluca
authors.initials: R
authors.lastname: Dulgheru
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
authors.forename: Luis
authors.initials: L
authors.lastname: Caballero
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
authors.forename: Saloua
authors.initials: S
authors.lastname: Laaraibi
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: Davin
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
authors.forename: Seisyou
authors.initials: S
authors.lastname: Kou
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
authors.forename: Damien
authors.initials: D
authors.lastname: Voilliot
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
authors.forename: Alain
authors.initials: A
authors.lastname: Nchimi
authors.affiliation: Human Genetics Unit, Laboratory of Thrombosis and Hemostasis, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Liège, Belgium.
authors.forename: Cécile
authors.initials: C
authors.lastname: Oury
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium. Electronic address: lpierard@chu.ulg.ac.be.
authors.forename: Luc A
authors.initials: LA
authors.lastname: Pierard
authors.affiliation: Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appilquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, E.S. Health Science Foundation, Lugo, RA, Italy. Electronic address: plancellotti@chu.ulg.ac.be.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D058070:Asymptomatic Diseases; D015415:Biomarkers; D018450:Disease Progression; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain