B-type natriuretic peptide as a biochemical marker of left ventricular diastolic function: assessment in asymptomatic patients 1 year after valve replacement for aortic stenosis

Abstract

OBJECTIVES: Left ventricular (LV) diastolic dysfunction after aortic valve replacement (AVR) carries a substantial risk of development of heart failure and reduced survival. In addition to echocardiography, B-type natriuretic peptide (BNP) provides a powerful incremental assessment of diastolic function. This study evaluates BNP as a marker of LV diastolic dysfunction in a cohort of patients with preserved LV ejection fraction who underwent AVR for pure aortic stenosis and the relationship between BNP values and the grade of LV diastolic dysfunction. METHODS:A total of 113 patients were included in the study. Echocardiographic evaluation was performed preoperatively, 5 days postoperatively and at 12-month follow-up, to assess LV dimensional and functional parameters. Diastolic function was labelled as normal, mild, moderate or severe dysfunction. Concomitantly, BNP levels were evaluated. RESULTS:Mild to severe diastolic dysfunction occurred preoperatively in all patients. At 12-month follow-up, 65 (62.5%) patients had mild and 25 (24.1%) moderate to severe diastolic dysfunction. BNP values, categorized for quartile distribution, correlated with diastolic dysfunction grade (P < 0.001 for each comparison). At receiver operating characteristic analysis, the BNP level of 120 pg/ml was 91% sensitive and 85% specific for diastolic disease, while 300 pg/ml was 80% sensitive and 91% specific for moderate or severe diastolic dysfunction. Twelve months after AVR, BNP values were strongly correlated with the significant echocardiographic parameters suggestive of diastolic dysfunction (P ≤ 0.006 in all cases). CONCLUSIONS:The BNP level following AVR is related to diastolic disease severity and may complement echocardiographic evaluation when symptoms are unclear and LV function is difficult to interpret.

Natriuretic peptides for the detection of diastolic dysfunction and heart failure with preserved ejection fraction—a systematic review and meta-analysis

“…Thirty studies were cross-sectional [ 18 , 20 , 22 , 32 – 58 ] and twenty-one [ 31 , 59 – 78 ] were case-control studies (Tables 1 and 2 ). Twenty-eight were performed in Europe [ 20 , 32 – 36 , 38 , 40 , 41 , 43 – 45 , 50 , 52 , 53 , 55 – 57 , 59 , 63 , 64 , 66 , 69 , 73 , 76 – 78 ], 11 in North America [ 22 , 37 , 39 , 46 , 49 , 54 , 65 , 70 , 72 , 74 , 75 ], 11 in Asia [ 31 , 42 , 47 , 51 , 58 , 60 – 62 , 67 , 68 , 71 ] and one was a multi-country study [ 48 ]. The control populations were either healthy controls ( N = 14) [ 31 , 35 , 59 , 60 , 62 , 65 , 67 – 69 , 71 , 72 , 75 – 77 ] or were recruited at the same department as the patient population, but without DD or HFpEF ( ...…”

“…Five DD studies included patients with HFpEF [ 38 , 43 , 48 , 73 , 76 ], one DD study included patients with signs and symptoms [ 44 ], but did not exclude on LVEF, and eight DD studies only included patients with LVEF above 45 or 50% [ 18 , 20 , 45 , 47 , 50 , 52 , 53 , 77 ]. The reference diagnoses used in the included studies varied from use of maximal velocity of the E-wave (e’) ( N = 10) [ 43 – 45 , 49 , 50 , 52 , 54 , 56 , 57 , 74 ] versus no tissue Doppler (TDI) measures ( N = 14) [ 18 , 20 , 22 , 38 , 46 – 48 , 51 , 53 , 55 , 73 , 76 – 78 ] for DD studies and, use of extensive criteria ( N = 13) [ 31 , 32 , 34 , 35 , 38 , 41 , 59 , 61 , 63 , 64 , 66 , 69 , 72 ], signs and symptoms of HF in combination with LVEF ( N = 11) [ 36 , 40 , 42 , 58 , 60 , 62 , 65 , 67 , 68 , 70 , 71 ], expert opinion ( N = 1) [ 33 ] or catheterization ( N = 3) [ …”

Echocardiographic determinants of LV functional improvement after transcatheter aortic valve replacement

“…Patients with moderate to severe AS usually have concentric LV hypertrophy associated with myocardial dysfunction due to abnormal calcium handling and increased myocardial interstitial fibrosis, which produces early LV diastolic abnormalities, left atrial remodeling , and late systolic chamber dysfunction . Mannacio et al demonstrated that BNP values are directly related to several transmitral flow parameters and tissue Doppler findings, indicative of impaired LV diastolic function in AS patients pre‐ and post‐AVR. In a recent study of 125 AS patients who have not undergone valve surgery, E/E′ ratio was the most predictive parameter of clinical events among clinical and imaging measurements .…”

Implications of myocardial dysfunction before and after aortic valve intervention

“…In the present study, NT-proBNP was found to be the sole predictor of high preoperative LV filling pressure, after adjusting for confounders. Additionally, previous studies have shown an association between NT-proBNP and diastolic function 37,[147][148][149][150] . Our method for the evaluation of high LV filling pressure, starting with E/A taking the age adjusted normal ranges into account for grading of diastolic function, was at least as good as left atrial index and E/é in identifying patients with increased levels of NT-proBNP.…”