title: Determinants and prognostic value of B-type natriuretic peptide in patients with aortic valve stenosis.
abstract: BACKGROUND
  The prognostic value of N-terminal fragment of pro B-type natriuretic peptide (Nt-proBNP) in aortic stenosis (AS) is still being debated. We sought to evaluate the determinants of Nt-proBNP in AS and its prognostic value in asymptomatic patients.
  
  
  METHODS
  Patients with pure isolated at least mild degenerative AS enrolled in our prospective cohort (2006-2013) constituted our population. Clinical and biological measurements as well as echocardiographic evaluations were performed at study entry for all patients. Severe AS was defined by a valve area <1cm2. Asymptomatic patients were contacted every six months and seen every year. The occurrence of AS-related events (sudden death, congestive heart failure or new onset of symptoms) within two years was recorded prospectively.
  
  
  RESULTS
  We enrolled 809 patients. Nt-proBNP increased with AS severity (p<0.0001) and symptomatic status (p<0.0001) but there was a wide overlap between groups of AS severity or symptomatic status. Nt-proBNP was the result of complex interactions between multiple determinants, including AS severity and symptomatic status but also age (p=0.0008), history of coronary artery disease (p=0.03), rhythm (p=0.007) and diastolic function (p<0.0001). Consequently, in asymptomatic patients with moderate/severe AS, normal ejection fraction and in sinus rhythm, Nt-proBNP was associated with AS-related events in univariate analysis (p=0.009) but not after adjustment for AS severity (p=0.12). Repeated Nt-proBNP measurements at one year did not improve their predictive value (p=0.43).
  
  
  CONCLUSIONS
  This study highlights the limitations of Nt-proBNP in AS and raises caution regarding its use, at least as a single factor, in the decision-making process regarding asymptomatic patients with AS.
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
authors.forename: Virginia
authors.initials: V
authors.lastname: Nguyen
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Cimadevilla
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Arangalage
authors.affiliation: Department of Biochemistry, Bichat Hospital, Paris, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Dehoux
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; Centre de Ressources Biologique, Bichat Hospital, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Codogno
authors.affiliation: Centre d'Investigation Clinique 007, Assistance Publique - Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.affiliation: Centre de Ressources Biologique, Bichat Hospital, Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tubiana
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France. Electronic address: david.messika-zeitoun@aphp.fr.
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Aortic stenosis; Natriuretic peptides; Prognosis