Prognostic value of B-type natriuretic peptide in elderly patients with aortic valve stenosis: the COFRASA–GENERAC study
- Claire Cimadevilla1,
- Caroline Cueff1,
- Guillaume Hekimian1,
- Monique Dehoux2,
- Laurent Lepage3,
- Bernard Iung1,
- Xavier Duval4,
- Virginie Huart5,
- Florence Tubach6,
- Alec Vahanian1,
- David Messika-Zeitoun1,7
- 1Department of Cardiology, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
- 2Department of Biochemistry, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
- 3Department of Cardiac Surgery, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
- 4Centre d'Investigation Clinique 007, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
- 5Centre de Resources Biologiques, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
- 6Department of Epidemiology, Biostatistic and Clinical research, Assistance Publique—Hôpitaux de Paris, Bichat Hospital, Paris, France
- 7INSERM U698 and University Paris 7, Bichat Hospital, Paris, France
- Correspondence to Dr David Messika-Zeitoun, Cardiovascular division, AP-HP, Bichat Hospital, 46 rue Henri Huchard, Paris 75018, France;
- Received 30 October 2012
- Revised 17 December 2012
- Accepted 19 December 2012
- Published Online First 24 January 2013
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.
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.