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 AE 19 months, 43 patients experienced a cardiac event. These patients were significantly older (73 AE 9

Serial B-Type Natriuretic Peptide in Aortic Stenosis: A Practical Tool for Prediction of Outcome and Intervention Timing?

“…The individual progression of AS severity can vary from patient to patient and is related to event rates. In the present issue of the Canadian Journal of Cardiology, Henri et al 13 report the results of a study that assessed the impact of serial measurements of BNP on anticipating outcome in asymptomatic patients with at least moderate AS and a preserved LV ejection fraction. A new approach using "annualized BNP" was applied for the analysis accounting for differences in follow-up time.…”

“…Importantly, the results of the study confirm that serial changes in BNP are useful to predict the development of class I indications of AVR. 2,13 A single BNP value may have less predictive value because it is influenced by the stage of the valve disease and possible comorbidities. The use of serial BNP changes over time may overcome this limitation because it provides information in addition to clinical and echocardiographic parameters and can be easily performed in any setting.…”

The value of global longitudinal strain and galectin-3 for predicting cardiovascular events in patients with severe aortic stenosis

“…In a series of 1953 consecutive patients with at least moderate AS, BNP clinical activation, defined as measured BNP/age was associated with higher longterm mortality [30]. Moreover, BNP levels, particularly in combination with echocardiographic markers of LV dysfunction, were shown to anticipate the development of symptoms in asymptomatic patients with severe AS [31] and to predict clinical outcomes [32] in such patients.…”

Brain Natriuretic Peptide as an Additional Metric for Determining Operative Candidates among Veterans with Aortic Stenosis

“…Biologic objective diagnostic metrics could supplement the existing guidelines put forth by the ACC/AHA regarding the treatment of AS by helping further stratify candidates for surgical valve replacement. We believe that BNP could be considered for inclusion into the next iteration of the ACC/ AHA guidelines for the treatment of AS because of its nature as a harbinger for loss of ventricular compensation [9] and proven track record as a prognostic indicator for negative outcomes following medical or surgical management. Historically, changes in structural metrics were considered the gold standard for progression of aortic stenosis, however, as study into cardiac physiology has progressed biologic markers have become readily available and may provide a more predictive measure of disease progression [10] [11].…”