Published online before print May 21, 2007, doi: 10.1161/CIRCULATIONAHA.106.654210
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(Circulation. 2007;115:2848-2855.)
© 2007 American Heart Association, Inc.
Valvular Heart Disease |
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
From the Department of Cardiology (J.B.-K., G.M., C.F., N.W.-P., F.R., H.B.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Quebec Heart Institute (P.P., J.G.D., C.B., D.M., Z.H.), Laval University, Sainte-Foy, Quebec, Canada; and the University of Ottawa Heart Institute (I.G.B, R.S.B), Ottawa, Ontario, Canada.
Correspondence to Jutta Bergler-Klein, MD, Department of Cardiology, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090 Vienna, Austria. E-mail jutta.bergler-klein{at}meduniwien.ac.at
Received August 11, 2006; accepted March 19, 2007.
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 
40 mm Hg, left ventricular ejection fraction 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 1.0 cm2 or >1.0 cm2). BNP was inversely related to ejection fraction at rest (Spearman correlation coefficient rs=–0.59, P<0.0001) and at peak stress (rs=–0.51, P<0.0001), effective orifice area at rest (rs=–0.50, P<0.0001) and at peak stress (rs=–0.46, P=0.0002), and mean transvalvular flow (rs=–0.31, P=0.01). BNP was directly related to valvular resistance (rs=0.42, P=0.0006) and wall motion score index (rs=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 
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 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.
CLINICAL PERSPECTIVE
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