Abstract 14217: Brain Natriuretic Peptide Levels in Patients With Severe Aortic Stenosis at High Surgical Risk: Clinical, Echocardiographic, and Hemodynamic Correlates and Prognosis
Background: Brain natriuretic peptide (BNP) is a marker of systolic and diastolic dysfunction and a strong predictor of mortality in patients with heart failure. The present study aimed to assess the relationship of BNP with aortic stenosis (AS) severity and prognosis.
Methods: The study cohort consisted of 289 high-risk patients with severe AS who were referred to participate in trial of transcatheter aortic valve implantation. Pts were divided into three tertils according to BNP level
Results: The vast majority of the baseline characteristics were similar among the groups. (Table) The STS and logistic EuroSCORE, NYHA class IV were significantly higher in the high level NP group. Ejection fraction and cardiac output were lower and pulmonary pressure was higher in the high level BNP group. There was no significant difference among the three groups re: aortic valve area. There was no significant correlation between BNP level and aortic valve area (r=-0.01, p=0.81). There was significant correlation was between BNP level and ejection fraction (r=-0.47, p<0.001), pulmonary pressure (r=0.33, p≤0.001) and NYHA class IV, p<0.001. The mortality rates during median follow up of 319 [110-655] days were significantly lower in the low level BNP groups compared to high level BNP groups (Figure) and there was significant association between BNP level and mortality with median BNP level 588 [320-1480] vs. 1100 [497-2200] pg/dl, p<0.001. The mean BNP did not change significantly immediately after balloon aortic valvuloplasty 1938±1516 vs. 1705±1579 (p=0.14) or after surgical AVR 775±937 vs. 544±697 (p=0.07), or after trans-catheter AVR 681±663 vs. 634±457pg/dl (p=0.37).
Conclusion: High BNP level in high-risk patients with severe AS is significantly associated with higher mortality. BNP level does not appear to be significantly associated with AS severity but mostly related to heart failure.
- © 2011 by American Heart Association, Inc.