Increased Plasma Natriuretic Peptide Levels Reflect Symptom Onset in Aortic Stenosis

Abstract

Background-The onset of symptoms is a critical point in the natural history of aortic stenosis and the cardinal indication for valve replacement. This study assessed the associations between natriuretic peptide levels, disease severity, and cardiac symptoms in aortic stenosis. Methods and Results-Seventy-four patients with isolated aortic stenosis underwent independent assessment of symptoms, transthoracic echocardiography, and measurement of plasma levels of atrial natriuretic peptide, brain natriuretic peptide (BNP), and N-BNP. Natriuretic peptide levels were also measured in 100 clinically normal control subjects. The aortic valve area was smaller in symptomatic patients (nϭ45) than in asymptomatic patients (nϭ29; mean, 0.71Ϯ0.23 cm 2 and 0.99Ϯ0.31 cm 2 , respectively; PϽ0.0001). Plasma natriuretic peptide levels were higher in symptomatic patients than in asymptomatic patients (for N-BNP: median, 112 versus 33 pmol/L; interquartile range, 70 to 193 versus 16 to 58 pmol/L, respectively; Pϭ0.0002). After adjustment for age, sex, serum creatinine, aortic valve area, and left ventricular ejection fraction, N-BNP levels were 1.74 times higher (95% confidence interval, 1.12 to 2.69) for symptomatic than asymptomatic patients with aortic stenosis (Pϭ0.014). Natriuretic peptide levels increased with the New York Heart Association class (for N-BNP median values were 13, 34, 105, and 202 pmol/L for normal control subjects, class I, class II, and class III/IV patients, respectively; interquartile ranges for the same patients were 8 to 21, 16 to 58, 57 to 159, and 87 to 394 pmol/L; PϽ0.0001). Similar associations were observed for BNP and atrial natriuretic peptide. Conclusions-Plasma natriuretic peptide levels are elevated in symptomatic patients with aortic stenosis. Measurement of natriuretic peptides may complement clinical and echocardiographic evaluation of patients with aortic stenosis.

Atrial Natriuretic Peptide Predicts Impaired Atrial Remodeling and Occurrence of Late Postoperative Atrial Fibrillation after Surgery for Symptomatic Aortic Stenosis

“…However, to our knowledge, NP has not been associated with impaired LA remodeling and the occurrence of late postoperative AF previously. We have firstly reported that N-ANP levels and age, which was lower in our small patient cohort compared to previous reports [2, 15], were independent predictors of late AF following surgery for AS. In addition, patients with postoperative AF episodes had significantly higher preoperative LA min and LA max levels and longer symptom duration compared to those without, though they were not found to be independent predictors.…”

“…ANP is cleared by enzymes, which are extensively expressed in the lung, kidney and the vascular wall [11]. Previously, ANP levels have been evaluated in AS patients and found to mirror symptom onset [15]. In addition, temporal changes in ANP values have been evaluated separately [6].…”

Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions

“…BNP levels are elevated in aortic stenosis and are linearly related to symptoms [92]. Furthermore, BNP values above 190 pg/ml portend a much worse outcome, suggesting that BNP may be useful in identifying subgroups of patients with aortic stenosis that may benefit from aortic valve replacement [93].…”

Biomarkers in Aortic Stenosis: A Systematic Review

“…45,47 In asymptomatic severe AS, baseline BNP levels are predictive of an abnormal blood pressure response to exercise, earlier symptom onset, and increased risk of re-hospitalization due to HF, need for AVR, and mortality. [48][49][50][51][52] Of note, most of these studies excluded patients with depressed LV function and/or concomitant valve disease which might otherwise cause elevated natriuretic peptide levels. 53,54 Hence, the results and conclusions of these studies apply to AS patients with otherwise normal cardiac structure and function.…”