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Aortic and vascular disease
Original research article
B-type natriuretic peptide in patients with asymptomatic severe aortic stenosis
  1. Kenji Nakatsuma1,
  2. Tomohiko Taniguchi2,
  3. Takeshi Morimoto3,
  4. Hiroki Shiomi2,
  5. Kenji Ando4,
  6. Norio Kanamori5,
  7. Koichiro Murata6,
  8. Takeshi Kitai7,
  9. Yuichi Kawase8,
  10. Chisato Izumi9,
  11. Makoto Miyake9,
  12. Hirokazu Mitsuoka10,
  13. Masashi Kato1,
  14. Yutaka Hirano11,
  15. Shintaro Matsuda2,
  16. Tsukasa Inada12,
  17. Kazuya Nagao12,
  18. Hiroshi Mabuchi13,
  19. Yasuyo Takeuchi14,
  20. Keiichiro Yamane15,
  21. Mamoru Toyofuku16,
  22. Mitsuru Ishii17,
  23. Eri Minamino-Muta2,
  24. Takao Kato2,
  25. Moriaki Inoko18,
  26. Tomoyuki Ikeda19,
  27. Akihiro Komasa20,
  28. Katsuhisa Ishii20,
  29. Kozo Hotta21,
  30. Nobuya Higashitani22,
  31. Yoshihiro Kato23,
  32. Yasutaka Inuzuka24,
  33. Chiyo Maeda25,
  34. Toshikazu Jinnai22,
  35. Yuko Morikami26,
  36. Naritatsu Saito2,
  37. Kenji Minatoya27,
  38. Takeshi Kimura2
  39. on behalf of the CURRENT AS Registry Investigators
  1. 1Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
  2. 2Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
  3. 3Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
  4. 4Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
  5. 5Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
  6. 6Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
  7. 7Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
  8. 8Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
  9. 9Department of Cardiology, Tenri Hospital, Tenri, Japan
  10. 10Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
  11. 11Department of Cardiology, Kinki University Hospital, Osakasayama, Japan
  12. 12Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
  13. 13Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
  14. 14Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
  15. 15Department of Cardiology, Nishikobe Medical Center, Kobe, Japan
  16. 16Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
  17. 17Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
  18. 18Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
  19. 19Department of Cardiology, Hikone Municipal Hospital, Hikone, Japan
  20. 20Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
  21. 21Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
  22. 22Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
  23. 23Department of Cardiology, Saiseikai Noe Hospital, Osaka, Japan
  24. 24Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan
  25. 25Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
  26. 26Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
  27. 27Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
  1. Correspondence to Professor Takeshi Kimura, Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; taketaka{at}kuhp.kyoto-u.ac.jp

Abstract

Objectives We sought to evaluate the prognostic impact of the B-type natriuretic peptide (BNP) levels in patients with asymptomatic severe aortic stenosis (AS), who were not referred for aortic valve replacement (AVR).

Methods We used data from a Japanese multicentre registry, the Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis Registry, which enrolled 3815 consecutive patients with severe AS. Of those, 387 asymptomatic patients who were not referred for AVR without left ventricular dysfunction and very severe AS were subdivided into four groups based on their BNP levels (BNP<100 pg/mL, n=201; 100≤BNP<200 pg/mL, n=94; 200≤BNP<300 pg/mL, n=42 and BNP>300 pg/mL, n=50).

Results The cumulative 5-year incidence of AS-related events (aortic valve-related death or heart failure hospitalisation) was incrementally higher with increasing BNP level (14.2%, 29.6%, 46.3% and 47.0%, p<0.001). After adjusting for confounders, the risk for AS-related events was incrementally greater with increasing BNP levels (HR: 1.97, 95% CI: 0.97 to 3.98, p=0.06; HR: 3.59, 95% CI: 1.55 to 8.32, p=0.03 and HR: 7.38, 95% CI: 3.21 to 16.9, p<0.001, respectively). Notably, asymptomatic patients with BNPlevels of <100 pg/mL had an event rate of only 2.1% at 1 year.

Conclusions Increased BNP level was associated with a higher risk for AS-related adverse events in patients with asymptomatic severe AS with normal left ventricular ejection fraction who were not referred for AVR. Asymptomatic patients with BNP levels of <100 pg/mL had relatively low event rate, who might be safely followed with watchful waiting strategy.

Trail registration number UMIN000012140.

  • aortic stenosis

https://doi.org/10.1136/heartjnl-2018-313746

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    Footnotes

    • Contributors TK had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: KN, TM, TT, TK. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: KN, TM, TK. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: KN, TM. Administrative, technical or material support: TK. Study supervision: TM, TK.

    • Funding This study was funded by Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The institutional review boards at all 27 participating centers (see the online supplementary appendix) approved the study protocol.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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