Focus Issue: Biomarkers in Cardiovascular Disease
State-of-the-Art Paper
Natriuretic Peptides in Common Valvular Heart Disease

https://doi.org/10.1016/j.jacc.2010.02.021Get rights and content
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Valvular heart disease, particularly aortic stenosis and mitral regurgitation, accounts for a large proportion of cardiology practice, and their prevalence is predicted to increase. Management of the asymptomatic patient remains controversial. Biomarkers have been shown to have utility in the management of cardiovascular disease such as heart failure and acute coronary syndromes. In this state-of-the-art review, we examine the current evidence relating to natriuretic peptides as potential biomarkers in aortic stenosis and mitral regurgitation. The natriuretic peptides correlate with measures of disease severity and symptomatic status and also can be used to predict outcome. This review shows that natriuretic peptides have much promise as biomarkers in common valvular heart disease, but the impact of their measurement on clinical practice and outcomes needs to be further assessed in prospective studies before routine clinical use becomes a reality.

Key Words

aortic
biomarkers
B-type natriuretic peptide
mitral regurgitation
natriuretic peptides
stenosis

Abbreviations and Acronyms

AF
atrial fibrillation
ANP
atrial natriuretic peptide
AS
aortic stenosis
AUC
area under the curve
AVA
aortic valve area
AVR
aortic valve replacement
BNP
B-type natriuretic peptide
CAD
coronary artery disease
CNP
C-type natriuretic peptide
LA
left atrial
LV
left ventricular
LVEF
left ventricular ejection fraction
LVESVI
left ventricular end-systolic volume index
LVMI
left ventricular mass index
MACE
major adverse cardiac event(s)
MR
mitral regurgitation
NPR
natriuretic peptide receptor
NT-proANP
N-terminal pro-atrial natriuretic peptide
NT-proBNP
N-terminal pro–B-type natriuretic peptide
NYHA
New York Heart Association
OR
odds ratio

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Dr. Steadman is supported by the British Heart Foundation ProjectGrant 07/068/2334. Prof. Ng has received grants in aid from BRAHMS AGfor biomarker research. Prof. Ng and Dr. McCann are supported by the Leicester National Institute for Health Research Cardiovascular Biomedical Research Unit.