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.

Authors: Bergler-Klein, Jutta; Mundigler, Gerald; Pibarot, Philippe; Burwash, Ian G.; Dumesnil, Jean G.Blais, ClaudiaFuchs, Christina; Mohty, Dania; Beanlands, Robert S. B.; Hachicha, Zeineb; Walter-Publig, Nicole; Rader, Florian; Baumgartner, Helmut
Abstract: 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.
Document Type: Article de recherche
Issue Date: 5 June 2007
Open Access Date: Restricted access
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/8410
This document was published in: Circulation, Vol. 115 (22), 2848-2855 (2007)
https://doi.org/10.1161/CIRCULATIONAHA.106.654210
American Heart Association
Alternative version: 10.1161/CIRCULATIONAHA.106.654210
17515464
Collection:Articles publiés dans des revues avec comité de lecture

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