Relation of N-Terminal Pro–B-Type Natriuretic Peptide to Severity of Valvular Aortic Stenosis

Weber, Michael; Arnold, Román; Rau, Monika; Brandt, Roland R.; Berkovitsch, Alexander; Mitrović, Veselin; Hamm, Christian W.

doi:10.1016/j.amjcard.2004.05.055

Cited by 112 publications

(80 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…26,27 Similar to other studies in patients with AS, BNP also increased with stenosis severity and demonstrated an inverse relation to valve area and direct relation to valve resistance. [17][18][19] Furthermore, BNP was significantly higher in TS AS than PS AS. This may be caused by the more extensive LV afterload in patients with more severe AS.…”

Section: Bnp In Low-flow Low-gradient Aortic Stenosismentioning

confidence: 95%

B-Type Natriuretic Peptide in Low-Flow, Low-Gradient Aortic Stenosis

et al. 2007

View full text Add to dashboard Cite

Background-The prognostic value of B-type natriuretic peptide (BNP) is unknown in low-flow, low-gradient aortic stenosis (AS). We sought to evaluate the relationship between AS and rest, stress hemodynamics, and clinical outcome. Methods and Results-BNP was measured in 69 patients with low-flow AS (indexed effective orifice area Ͻ0.6 cm 2 /m 2 , mean gradient Յ40 mm Hg, left ventricular ejection fraction Յ40%). All patients underwent dobutamine stress echocardiography and were classified as truly severe or pseudosevere AS by their projected effective orifice area at normal flow rate of 250 mL/s (effective orifice area Յ1.0 cm 2 or Ͼ1.0 cm 2 ). BNP was inversely related to ejection fraction at rest (Spearman correlation coefficient r s ϭϪ0.59, PϽ0.0001) and at peak stress (r s ϭϪ0.51, PϽ0.0001), effective orifice area at rest (r s ϭϪ0.50, PϽ0.0001) and at peak stress (r s ϭϪ0.46, Pϭ0.0002), and mean transvalvular flow (r s ϭϪ0.31, Pϭ0.01). BNP was directly related to valvular resistance (r s ϭ0.42, Pϭ0.0006) and wall motion score index (r s ϭ0.36, Pϭ0.004). BNP was higher in 29 patients with truly severe AS versus 40 with pseudosevere AS (median, 743 pg/mL [Q1, 471; Q3, 1356] versus 394 pg/mL [Q1, 191 to Q3, 906], Pϭ0.012). BNP was a strong predictor of outcome. In the total cohort, cumulative 1-year survival of patients with BNP Ն550 pg/mL was only 47Ϯ9% versus 97Ϯ3% with BNP Ͻ550 (PϽ0.0001). In 29 patients who underwent valve replacement, postoperative 1-year survival was also markedly lower in patients with BNP Ն550 pg/mL (53Ϯ13% versus 92Ϯ7%). Conclusions-BNP is significantly higher in truly severe than pseudosevere low-gradient AS and predicts survival of the whole cohort and in patients undergoing valve replacement.

show abstract

Section: Bnp In Low-flow Low-gradient Aortic Stenosismentioning

confidence: 95%

B-Type Natriuretic Peptide in Low-Flow, Low-Gradient Aortic Stenosis

et al. 2007

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Bnp and As Severitymentioning

confidence: 99%

“…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 …”

Section: Bnp and As Severitymentioning

confidence: 99%

Natriuretic Peptides for Risk Stratification of Patients With Valvular Aortic Stenosis

Parikh

Kim

Siegel

et al. 2015

Circ: Heart Failure

View full text Add to dashboard Cite

“…This may also be a conservative estimate of the potential usefulness of this test given that we were only investigating the use of the test in determining systolic dysfunction rather than other structural or functional abnormalities. There is now evidence to suggest that NT proBNP may be useful in the detection of structural or valvular deficiencies which may further affect peri-operative decision making [20]. In our study, retrospective analysis of all severe valvular abnormalities determined by TTE were associated with NT proBNP levels above our cut off value of 38.2 pmol.l )1 and would have been identified as true positives triggering the need for a confirmatory TTE.…”

Section: Discussionmentioning

confidence: 80%

The use of N‐Terminal pro‐B Type Natriuretic Peptide in a pre‐operative setting to predict left ventricular systolic dysfunction on echocardiogram*

et al. 2008

View full text Add to dashboard Cite

SummaryHeart failure is a major risk factor for adverse postoperative events following non-cardiac surgery. The use of transthoracic echocardiogram as a pre-operative investigation to assess cardiac dysfunction has limitations in this setting. The N-Terminal fragment of B-Type natriuretic peptide (NT proBNP) has been used in screening for heart failure. We have investigated the use of NT proBNP as a screening tool for left ventricular systolic dysfunction to reduce the requirement for preoperative echocardiograms. Ninety-eight pre-operative non-cardiac surgical patients scheduled to undergo echocardiography were assessed clinically and with an NT proBNP measurement. Echocardiogram was used to define two groups of patients depending on the presence or absence of abnormal left ventricular function and the NT proBNP level was compared between the groups using non-parametric and receiver-operator-characteristic (ROC) curve analysis. In terms of preoperative screening, a NT proBNP of <38.2 pmol.l )1 had a 100% negative predictive value in predicting patients with normal left ventricular systolic function and would have prevented the requirement for echocardiogram in 43% of pre-operative patients. NT proBNP was superior to electrocardiological and clinical criteria for detection of a normal echocardiogram. This may have significant impact in the pre-operative assessment of patients undergoing non-cardiac surgery. Heart failure involving left ventricular systolic dysfunction (LVSD) is a major risk factor for adverse peri-operative cardiovascular events [1]. Pre-operative recognition of LVSD is an important component of anaesthetic assessment. However, patients with cardiac dysfunction are often asymptomatic and where symptoms do exist they may be relatively non-specific. One investigational approach is to use indices determined by the use of resting transthoracic echocardiogram (TTE) for the assessment of cardiac dysfunction. In many centres this is seen as the 'gold standard' non-invasive pre-operative test. However, there are clinical and practical disadvantages associated with this simple investigational approach. The decision to obtain an echocardiogram is based on various pre-operative criteria which may vary between clinicians and are not consistently associated with subsequent abnormalities on echocardiogram. TTE is also relatively expensive and in many centres has a significant waiting list for its availability, since other specialties with more direct evidence for the use of TTE compete with pre-operative services for its availability.It follows that the ability of a biochemical marker to reliably and rapidly screen for cardiac dysfunction in patients presenting for major surgery would have considerable benefit both in reducing the requirement for preoperative TTE and assisting in the anaesthetic assessment of these patients.

show abstract

Relation of N-Terminal Pro–B-Type Natriuretic Peptide to Severity of Valvular Aortic Stenosis

Cited by 112 publications

References 11 publications

B-Type Natriuretic Peptide in Low-Flow, Low-Gradient Aortic Stenosis

B-Type Natriuretic Peptide in Low-Flow, Low-Gradient Aortic Stenosis

Natriuretic Peptides for Risk Stratification of Patients With Valvular Aortic Stenosis

The use of N‐Terminal pro‐B Type Natriuretic Peptide in a pre‐operative setting to predict left ventricular systolic dysfunction on echocardiogram*

Contact Info

Product

Resources

About