Abstract 9451: Determinant Factors of Elevated Plasma B-type Natriuretic Peptide Level in Severe Aortic Stenosis

Abstract

Background: Elevated plasma B-type natriuretic peptide (BNP) level reflects left ventricular (LV) dysfunction and is associated with poor outcome in aortic stenosis (AS). We aimed to determine the echocardiographic and clinical factors that are associated with elevated plasma BNP level in patients with severe AS.

Methods: We performed echocardiography in 142 patients (age 72±10 years) with severe AS (aortic valve area (AVA) < 1.0cm²). We excluded patients with chronic renal failure and other significant valvular disease. We used multivariate linear regression analysis to evaluate factors that are associated with the plasma BNP levels in these patients.

Results: Mean AVA was 0.77±0.16cm². The factors associated with plasma BNP levels were left ventricular (LV) ejection fraction, E/A, E/e’, left atrial diameter, estimated systolic pulmonary artery pressure (SPAP), AVA, LV mass index, e’, systolic systemic blood pressure and the presence of atrial fibrillation (Table). In multivariate stepwise linear regression analysis, LV ejection fraction was the strongest independent determinants of plasma BNP level. In addition, estimated SPAP, and E/e’, and AVA were also found to be independently associated with plasma BNP level.

Conclusions: In patients with severe AS, plasma BNP levels mainly correlates with LV systolic dysfunction. However, LV diastolic dysfunction, elevated pulmonary hypertension, and AS severity are also independently associated with elevated plasma BNP levels in severe AS.