Document Detail


Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis.
MedLine Citation:
PMID:  15117847     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The prognostic value of natriuretic peptides in aortic stenosis (AS) remains unknown. METHODS AND RESULTS: B-type natriuretic peptide (BNP), N-terminal BNP (NtBNP), and N-terminal atrial natriuretic peptide (NtANP) were determined in 130 patients with severe AS (mean age, 70+/-12 years; mean gradient, 64+/-21 mm Hg; valve area, 0.64+/-0.15 cm2) who were followed up for 377+/-150 days. Natriuretic peptides increased with NYHA class and with decreasing ejection fraction (EF). Even asymptomatic patients frequently had elevated neurohormones. Asymptomatic patients who developed symptoms during follow-up had higher BNP and NtBNP levels at entry compared with those remaining asymptomatic (median for NtBNP, 131 pmol/L [interquartile range, 50 to 202 pmol/L] versus 31 pmol/L [range, 19 to 56 pmol/L]; P<0.001). Symptom-free survival at 3, 6, 9, and 12 months for patients with NtBNP <80 versus > or =80 pmol/L was 100%, 88+/-7%, 88+/-7%, and 69+/-13% compared with 92+/-8%, 58+/-14%, 35+/-15%, and 18+/-15%, respectively (P<0.001). Seventy-nine patients eventually underwent surgery because of symptoms. Considering preoperative neurohormone levels, age, NYHA class, aortic valve area, EF, and presence of coronary artery disease, we found that neurohormones, EF, and NYHA class predicted survival; neurohormones predicted postoperative symptomatic status; and neurohormones and preoperative EF predicted postoperative EF. However, by multivariate analysis, NtBNP was the only independent predictor of outcome. CONCLUSIONS: In severe AS, natriuretic peptides provide important prognostic information beyond clinical and echocardiographic evaluation. NtBNP independently predicts symptom-free survival, and preoperative NtBNP independently predicts postoperative outcome with regard to survival, symptomatic status, and left ventricular function. Thus, neurohormones may gain particular importance for timing of surgery in asymptomatic severe AS.
Authors:
Jutta Bergler-Klein; Ursula Klaar; Maria Heger; Raphael Rosenhek; Gerald Mundigler; Harald Gabriel; Thomas Binder; Richard Pacher; Gerald Maurer; Helmut Baumgartner
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Publication Detail:
Type:  Journal Article     Date:  2004-04-26
Journal Detail:
Title:  Circulation     Volume:  109     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-05-18     Completed Date:  2004-10-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2302-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology and the Ludwig Boltzmann Institute of Cardiovascular Research, University of Vienna, Vienna, Austria.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve Stenosis / blood*,  complications,  mortality,  surgery,  ultrasonography
Atrial Natriuretic Factor / blood*
Biological Markers
Disease Progression
Disease-Free Survival
Dyspnea / etiology
Female
Heart Failure / blood,  etiology,  ultrasonography
Heart Valve Prosthesis Implantation / statistics & numerical data*
Humans
Life Tables
Male
Middle Aged
Natriuretic Peptide, Brain / blood*
Nerve Tissue Proteins / blood*
Peptide Fragments / blood*
Prognosis
Prospective Studies
Protein Precursors / blood*
Severity of Illness Index
Single-Blind Method
Stroke Volume
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 0/N-terminal proatrial natriuretic peptide; 0/Nerve Tissue Proteins; 0/Peptide Fragments; 0/Protein Precursors; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 85637-73-6/Atrial Natriuretic Factor

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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