13 research outputs found
BNP and Strain in Aortic Stenosis
Background
In aortic stenosis (AS), symptoms and left ventricular (LV) dysfunction represent a later disease state, and objective parameters that identify incipient LV dysfunction are needed. We sought to determine prognostic utility of brain natriuretic peptide (BNP) and left ventricular global longitudinal strain (LVāGLS) in patients with aortic valve area <1.3 cm2.
Methods and Results
Fiveāhundred and thirtyāone patients between January 2007 and December 2008 with aortic valve area <1.3 cm2(86% with aortic valve area ā¤1.1 cm2) and left ventricular ejection fraction ā„50% who had BNP drawn ā¤90 days from initial echo were included. Society of Thoracic Surgeons (STS) score and mortality were recorded. Mean STS score, glomerular filtration rate, and median BNP were 11Ā±5, 73Ā±35 mL/min per 1.73 m , and 141 (60ā313) pg/mL, respectively; 78% were in New York Heart Association class ā„II. Mean LVāstroke volume index (LVāSVI) and LVāGLS were 39Ā±10 mL/m2 and ā13.9Ā±3%. At 4.7Ā±2 years, 405 patients (76%) underwent aortic valve replacement; 161 died (30%). On multivariable survival analysis, age (hazard ratio [HR] 1.46), New York Heart Association class (HR1.27), coronary artery disease (HR 1.72), decreasing glomerular filtration rate (HR 1.15), increasing BNP (HR 1.16), worsening LVāGLS (HR 1.13) and aortic valve replacement (time dependent) (HR 0.34) predicted survival (all P<0.01). For mortality, the cāstatistic incrementally increased as follows (all P<0.01): STS score (0.60 [0.58ā0.64]), STS score+BNP (0.67 [0.62ā0.70]), and STS score+BNP+LVāGLS (0.74 [0.68ā0.78]).
Conclusions
In normal LVEF patients with significant aortic stenosis, BNP and LVāGLS provide incremental (additive not duplicative) prognostic information over established predictors, suggesting that both play a synergistic role in defining outcomes