Abstract 14639: Incremental Prognostic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Patients with Significant Aortic Stenosis
Background: We sought to determine the incremental prognostic utility of brain natriuretic peptide (BNP) & left ventricular global longitudinal strain (LV-GLS) in patients with moderate-severe & severe aortic stenosis (AS) & preserved LV ejection fraction (LVEF).
Methods: We studied 531 AS patients between 1/07-12/08 with aortic valve area (AVA) < 1.3cm2 & LVEF ≥ 50% who had BNP level drawn ≤90 days from initial echo. Clinical & echo variables were recorded. Based on AVA & mean gradient (MG), patients were classified as moderately severe AS (AVA 1.1-1.3cm2, 66±16 years, 68% men), standard severe (AVA ≤1.0cm2, MG ≥40mmHg, 72±11 years, 60% men) & low gradient (paradoxic) severe AS (AVA ≤1.0cm2, MG <40mmHg, 72±12 years, 50% men). Euroscore was calculated. All-cause mortality was recorded.
Results: Mean Euroscore, glomerular filtration rate (GFR) & median BNP were 8±3, 73±35 ml/min/1.73 m2 & 141 [60-313] pg/ml; while 78% were in New York Heart Association Class (NYHA) ≥II. Mean LV-stroke volume index & LV-GLS were 39±10 ml/m2 & -13.9±3 %. At 4.7 ± 2 years, 405 patients (76%) underwent aortic valve replacement (AVR) & there were 131 deaths (30%). On multivariable survival analysis, age (Hazard ratio or HR 1.46), NYHA class (HR 1.27), coronary artery disease (HR 1.72), decreasing GFR (HR 1.15), increasing BNP (HR 1.16), worsening LV-GLS (HR 1.13) & AVR (time dependent covariate analysis) (HR 0.34) were independent predictors of survival. Results of net reclassification improvement (NRI) are shown in Figure 1. Kaplan-Meier curves of NYHA class vs BNP &/or LV-GLS & AVR vs BNP &/or LV-GLS are shown in Figures 2a-b.
Conclusions: In patients with significant AS & preserved LVEF, BNP & LV-GLS independently predict mortality, providing improved risk classification, independent of clinical & echo variables. Assessment of LV-GLS & BNP improves risk stratification of AS patients with a preserved LVEF, especially asymptomatic or deemed at a low risk.
Author Disclosures: A. Goodman: None. K. Kusunose: None. Z.B. Popovic: None. R. Parikh: None. T. Barr: None. R.A. Grimm: None. J.F. Sabik: None. L. Rodriguez: None. L.G. Svensson: None. B.P. Griffin: None. M.Y. Desai: None.
- © 2014 by American Heart Association, Inc.