Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis

• Published in: Circulation (New York, N.Y.) Vol. 107; no. 14; pp. 1884 - 1890
• Main Authors: GERBER, Ivor L, STEWART, Ralph A. H, LEGGET, Malcolm E, WEST, Teena M, FRENCH, Renelle L, SUTTON, Timothy M, YANDLE, Timothy G, FRENCH, John K, RICHARDS, A. Mark, WHITE, Harvey D
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 15.04.2003; American Heart Association, Inc
• Subjects: Age Factors; Angina Pectoris - blood; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - diagnostic imaging; Atrial Natriuretic Factor - blood; Biological and medical sciences; Cardiology. Vascular system; Echocardiography; Endocardial and cardiac valvular diseases; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Natriuretic Peptide, Brain - blood; Nerve Tissue Proteins - blood; Peptide Fragments - blood; ROC Curve; Sensitivity and Specificity; Sex Factors; Syncope - blood; Sonography; Human; Echocardiography; Prognosis; valves; Peptide hormone; Cardiovascular disease; Narrowing; Atrial natriuretic peptide; stenosis; Blood plasma; natriuretic peptides; Natriuretic hormone; Cardiac valvular disease; atrial natriuretic factor; Severity score; Aortic valve
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.0000060533.79248.0c

The onset of symptoms is a critical point in the natural history of aortic stenosis and the cardinal indication for valve replacement. This study assessed the associations between natriuretic peptide levels, disease severity, and cardiac symptoms in aortic stenosis. Seventy-four patients with isolated aortic stenosis underwent independent assessment of symptoms, transthoracic echocardiography, and measurement of plasma levels of atrial natriuretic peptide, brain natriuretic peptide (BNP), and N-BNP. Natriuretic peptide levels were also measured in 100 clinically normal control subjects. The aortic valve area was smaller in symptomatic patients (n=45) than in asymptomatic patients (n=29; mean, 0.71+/-0.23 cm2 and 0.99+/-0.31 cm2, respectively; P<0.0001). Plasma natriuretic peptide levels were higher in symptomatic patients than in asymptomatic patients (for N-BNP: median, 112 versus 33 pmol/L; interquartile range, 70 to 193 versus 16 to 58 pmol/L, respectively; P=0.0002). After adjustment for age, sex, serum creatinine, aortic valve area, and left ventricular ejection fraction, N-BNP levels were 1.74 times higher (95% confidence interval, 1.12 to 2.69) for symptomatic than asymptomatic patients with aortic stenosis (P=0.014). Natriuretic peptide levels increased with the New York Heart Association class (for N-BNP median values were 13, 34, 105, and 202 pmol/L for normal control subjects, class I, class II, and class III/IV patients, respectively; interquartile ranges for the same patients were 8 to 21, 16 to 58, 57 to 159, and 87 to 394 pmol/L; P<0.0001). Similar associations were observed for BNP and atrial natriuretic peptide. Plasma natriuretic peptide levels are elevated in symptomatic patients with aortic stenosis. Measurement of natriuretic peptides may complement clinical and echocardiographic evaluation of patients with aortic stenosis.