Published online before print March 31, 2003, doi: 10.1161/01.CIR.0000060533.79248.0C
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(Circulation. 2003;107:1884.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Increased Plasma Natriuretic Peptide Levels Reflect Symptom Onset in Aortic Stenosis
From the Cardiology Department, Green Lane Hospital, Auckland, New Zealand (I.L.G., R.A.H.S., M.E.L., T.M.W., R.L.F., T.M.S, J.K.F., H.D.W.); and the Cardioendocrine Research Group, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand (T.G.Y., A.M.R.).
Correspondence to Dr Ralph Stewart, Cardiovascular Research Suite, Green Lane Hospital, Private Bag 92-189, Auckland 1030, New Zealand. E-mail rstewart{at}adhb.govt.nz
Background— 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.
Methods and Results— 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.
Conclusions— 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.
Key Words: atrial natriuretic factor • echocardiography • natriuretic peptides • stenosis • valves
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