Prognostic value of N-terminal pro-B-type natriuretic peptide for conservatively and surgically treated patients with aortic valve stenosis
Open Access
- 1 November 2006
- Vol. 92 (11), 1639-1644
- https://doi.org/10.1136/hrt.2005.085506
Abstract
Objective: To evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with aortic stenosis being treated conservatively or undergoing aortic valve replacement (AVR). Methods: 159 patients were followed up for a median of 902 days. 102 patients underwent AVR and 57 were treated conservatively. NT-proBNP at baseline was raised in association with the degree of severity and of functional status. Results: During follow up 21 patients (13%) died of cardiac causes or required rehospitalisation for decompensated heart failure. NT-proBNP at baseline was higher in patients with an adverse outcome than in event-free survivors (median 623 (interquartile range 204–1854) pg/ml v 1054 (687–2960) pg/ml, p = 0.028). This difference was even more obvious in conservatively treated patients (331 (129–881) pg/ml v 1102 (796–2960) pg/ml, p = 0.002). Baseline NT-proBNP independently predicted an adverse outcome in the entire study group and in particular in conservatively treated patients (area under the curve (AUC) = 0.65, p = 0.028 and AUC = 0.82, p = 0.002, respectively) but not in patients undergoing AVR (AUC = 0.544). At a cut-off value of 640 pg/ml, baseline NT-proBNP was discriminative for an adverse outcome. Conclusion: NT-proBNP concentration is related to severity of aortic stenosis and provides independent prognostic information for an adverse outcome. However, this predictive value is limited to conservatively treated patients. Thus, the data suggest that assessing NT-proBNP may have incremental value for selecting the optimal timing of valve replacement.Keywords
This publication has 14 references indexed in Scilit:
- Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve diseaseEuropean Heart Journal, 2005
- Increased Plasma Natriuretic Peptide Levels Reflect Symptom Onset in Aortic StenosisCirculation, 2003
- Should early elective surgery be performed in patients with severe but asymptomatic aortic stenosis?Published by Oxford University Press (OUP) ,2002
- Recommendations on the management of the asymptomatic patient with valvular heart diseaseEuropean Heart Journal, 2002
- Aortic StenosisNew England Journal of Medicine, 2002
- Natriuretic peptides in patients with aortic stenosisAmerican Heart Journal, 2001
- Plasma N‐terminal pro BNP and cardiotrophin‐1 are elevated in aortic stenosisEuropean Journal of Heart Failure, 2001
- Prevalence of aortic valve abnormalities in the elderly: An echocardiographic study of a random population sampleJournal of the American College of Cardiology, 1993
- Prevalence and severity of valvular aortic stenosis determined by Doppler echocardiography and its association with echocardiographic and electrocardiographic left ventricular hypertrophy and physical signs of aortic stenosis in elderly patientsThe American Journal of Cardiology, 1991
- Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method.Circulation, 1977