B-Type Natriuretic Peptide Clinical Activation in Aortic Stenosis

Objectives This study was conducted to define the association between serum B-type natriuretic peptide (BNP) activation and survival after the diagnosis of aortic stenosis (AS). Background In AS, the link between BNP levels and clinical outcome is in dispute. Failure to account for the normal shifti...

Full description

Saved in:
Bibliographic Details
Published in:Journal of the American College of Cardiology 2014-05, Vol.63 (19), p.2016-2025
Main Authors: Clavel, Marie-Annick, DVM, PhD, Malouf, Joseph, MD, Michelena, Hector I., MD, Suri, Rakesh M., MD, DPhil, Jaffe, Allan S., MD, Mahoney, Douglas W., MS, Enriquez-Sarano, Maurice, MD
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Age
aortic stenosis
Cardiology
Cardiovascular
Clinical medicine
Disease
Doppler echocardiography
Flow velocity
Heart
Heart attacks
Hypotheses
Internal Medicine
Mortality
Multivariate analysis
natriuretic peptide
Peptides
Studies
valvular heart disease
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objectives This study was conducted to define the association between serum B-type natriuretic peptide (BNP) activation and survival after the diagnosis of aortic stenosis (AS). Background In AS, the link between BNP levels and clinical outcome is in dispute. Failure to account for the normal shifting of BNP ranges with aging in men and women, not using hard endpoints (survival), and not enrolling large series of patients have contributed to the uncertainty. Methods A program of prospective measurement of BNP levels with Doppler echocardiographic AS assessment during the same episode of care was conducted. BNP ratio (measured BNP/maximal normal BNP value specific to age and sex) >1 defined BNP clinical activation. Results In 1,953 consecutive patients with at least moderate AS (aortic valve area 1.03 ± 0.26 cm2 ; mean gradient 36 ± 19 mm Hg), median BNP level was 252 pg/ml (interquartile range: 98 to 592 pg/ml); BNP ratio 2.46 (interquartile range 1.03 to 5.66); ejection fraction (EF) 57% ± 15%, and symptoms present in 60% of patients. After adjustment for all survival determinants, BNP clinical activation (BNP ratio >1) independently predicted mortality after diagnosis (p < 0.0001; hazard ratio [HR]: 1.91; 95% CI: 1.55 to 2.35) and provided incremental power to the survival predictive model (p 
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2014.02.581