Heart failure in patients with aortic stenosis: Clinical and prognostic significance of carbohydrate antigen 125 and brain natriuretic peptide measurement

Natriuretic Peptides for Risk Stratification of Patients With Valvular Aortic Stenosis

“…As shown in Table 2, natriuretic peptides may be useful to detect this maladaptive transition because elevated levels are associated with increased LV and left atrial dimensions, decreased LV function, and increased systolic pulmonary artery pressure. 2,13,16,21,27,29 Figure 4B demonstrates that in most studies, there is an inverse correlation between higher levels of natriuretic peptides and ejection fraction in patients with AS. 2,9,13,15,16,21,22,27,34 One large prospective study of 289 patients referred for TAVR found that higher levels of BNP were independently associated with lower ejection fraction (35.5% versus 55.4%).…”

“…20 Eight of 10 studies found that smaller aortic valve area is associated with higher BNP/NT-proBNP levels. 9,10,13,15,19,[21][22][23] Ben-Dor et al 24 found that greater levels of BNP also correlate significantly with higher surgical risk and atrial fibrillation, lower ejection fraction and higher pulmonary, and LV pressures, but they did not find that BNP correlated with aortic valve area, which is in contrast to several studies that found BNP levels are linked to AS severity. 17,20,25 One possible explanation for this negative finding was a relatively high prevalence of chronic kidney disease (45%) and LV dysfunction, both of which can confound measurement of BNP.…”

“…With regard to mean aortic valve gradient, 5 of 7 studies listed in Table 2 showed that higher BNP or NT-proBNP levels are associated with a greater mean aortic valve gradient. 5,10,13,17,19,21 …”

“…9,13,15,16,21,22,[25][26][27][28][29] LV hypertrophy (LVH) develops initially as adaptive response to pressure overload in patients with AS. Increase BNP gene expression leading to greater levels of natriuretic peptides may reflect more pronounced hypertrophic myocardial growth from elevated LV wall stress caused by increased afterload.…”

“…Others have confirmed this relationship between natriuretic peptide levels and LVMI in patients with chronic severe AS. 5,13,15,16,20,21,23,26,27,29,31,32 Eccentric LVH-which may be indicative of a later stage of LV decompensation or mixed regurgitant/stenotic lesions-is associated with higher BNP levels than concentric LVH. 16 The same correlation between BNP levels and LVMI was found in a study of patients undergoing transapical TAVR.…”