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Heart 99:461-467 doi:10.1136/heartjnl-2012-303284
  • Valvular heart disease
  • Original article

Prognostic value of B-type natriuretic peptide in elderly patients with aortic valve stenosis: the COFRASA–GENERAC study

  1. David Messika-Zeitoun1,7
  1. 1Department of Cardiology, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
  2. 2Department of Biochemistry, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
  3. 3Department of Cardiac Surgery, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
  4. 4Centre d'Investigation Clinique 007, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
  5. 5Centre de Resources Biologiques, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
  6. 6Department of Epidemiology, Biostatistic and Clinical research, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
  7. 7INSERM U698 and University Paris 7, Bichat Hospital, Paris, France
  1. Correspondence to Dr David Messika-Zeitoun, Cardiovascular division, AP-HP, Bichat Hospital, 46 rue Henri Huchard, Paris 75018, France; david.messika-zeitoun{at}bch.aphp.fr
  • Received 30 October 2012
  • Revised 17 December 2012
  • Accepted 19 December 2012
  • Published Online First 24 January 2013

Abstract

Objective Previous studies suggested an independent prognostic value of B-type natriuretic peptide (BNP) in aortic valve stenosis (AS) but were impeded by small sample sizes and inclusion of relatively selected young patients. We aimed to evaluate the relationship among N-terminal fragment of proBNP (Nt-proBNP), AS severity, symptoms and outcome in a large cohort of elderly patients with AS.

Design Observational cohort study, COhorte Française de Retrecissement Aortique du Sujet Agé (clinicalTrial.gov number-NCT00338676) and GENEtique du Retrecissement Aortique (clinicalTrial.gov number-NCT00647088).

Setting Single-centre study.

Patients Patients older than 70 years with at least mild AS.

Interventions None.

Measurements A comprehensive clinical, biological and echocardiographic evaluation was performed at study entry. Asymptomatic patients were prospectively followed on a 6-months basis and AS-related events (sudden death, congestive heart failure or new onset of AS-related symptoms) collected.

Results We prospectively enrolled 361 patients (79±6 years, 230 severe AS). Nt-proBNP increased with the grade of AS severity and the NYHA class (all p<0.0001) but there was an important overlap between grades/classes. Consequently, diagnostic value of Nt-proBNP for the diagnosis of severe symptomatic AS was only modest (area under the curve of the receiver operator characteristic analysis=0.73). At 2 years, 28 AS-related events occurred among 142 asymptomatic patients prospectively followed. Nt-proBNP was associated with outcome in univariate analysis (p=0.04) but not after adjustment for age, gender and AS severity (p=0.40).

Conclusions The present study clearly highlights the limitations of Nt-proBNP for the evaluation and management of AS patients. Our results suggest that Nt-proBNP should be considered cautiously, at least as a single criterion, in the decision-making process of AS patients especially in the elderly population.