Document Detail

B-type natriuretic peptide in low-flow, low-gradient aortic stenosis: relationship to hemodynamics and clinical outcome: results from the Multicenter Truly or Pseudo-Severe Aortic Stenosis (TOPAS) study.
MedLine Citation:
PMID:  17515464     Owner:  NLM     Status:  MEDLINE    
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 < 0.6 cm2/m2, mean gradient < or = 40 mm Hg, left ventricular ejection fraction < or = 40%). 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 < or = 1.0 cm2 or > 1.0 cm2). BNP was inversely related to ejection fraction at rest (Spearman correlation coefficient r(s)=-0.59, P<0.0001) and at peak stress (r(s)=-0.51, P<0.0001), effective orifice area at rest (r(s)=-0.50, P<0.0001) and at peak stress (r(s)=-0.46, P=0.0002), and mean transvalvular flow (r(s)=-0.31, P=0.01). BNP was directly related to valvular resistance (r(s)=0.42, P=0.0006) and wall motion score index (r(s)=0.36, P=0.004). 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], P=0.012). BNP was a strong predictor of outcome. In the total cohort, cumulative 1-year survival of patients with BNP > or = 550 pg/mL was only 47+/-9% versus 97+/-3% with BNP < 550 (P<0.0001). In 29 patients who underwent valve replacement, postoperative 1-year survival was also markedly lower in patients with BNP > or = 550 pg/mL (53+/-13% versus 92+/-7%). 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.
Jutta Bergler-Klein; Gerald Mundigler; Philippe Pibarot; Ian G Burwash; Jean G Dumesnil; Claudia Blais; Christina Fuchs; Dania Mohty; Rob S Beanlands; Zeineb Hachicha; Nicole Walter-Publig; Florian Rader; Helmut Baumgartner
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2007-05-21
Journal Detail:
Title:  Circulation     Volume:  115     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-06-05     Completed Date:  2007-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2848-55     Citation Subset:  AIM; IM    
Department of Cardiology, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090 Vienna, Austria.
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MeSH Terms
Aged, 80 and over
Aortic Valve Stenosis / classification,  complications,  drug therapy*,  physiopathology*
Blood Pressure
Cardiac Output
Cardiovascular Abnormalities / epidemiology
Heart Rate
Middle Aged
Natriuretic Agents / therapeutic use
Natriuretic Peptide, Brain / therapeutic use*
Ventricular Function, Left
Reg. No./Substance:
0/Natriuretic Agents; 114471-18-0/Natriuretic Peptide, Brain
Comment In:
Circulation. 2007 Jun 5;115(22):2799-800   [PMID:  17548741 ]

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