Clinical Research
Biomarkers in Valve Disease
Prospective Validation of the Prognostic Usefulness of B-Type Natriuretic Peptide in Asymptomatic Patients With Chronic Severe Aortic Regurgitation

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Objectives

The purpose of this study was to determine the independent and additive prognostic value of B-type natriuretic peptide (BNP) in patients with severe asymptomatic aortic regurgitation and normal left ventricular function.

Background

Early surgery could be advisable in selected patients with chronic severe aortic regurgitation, but there are no uniform criteria to identify candidates who could benefit from this strategy. Assessment of BNP has not been studied for this purpose.

Methods

We prospectively evaluated 294 consecutive patients with severe asymptomatic organic aortic regurgitation and left ventricular ejection fraction above 55%. The first 160 consecutive patients served as the derivation cohort and the next 134 patients served as a validation cohort. The combined endpoint was the occurrence of symptoms of congestive heart failure, left ventricular dysfunction, or death at follow-up.

Results

The endpoint was reached in 45 patients (28%) of the derivation set and in 35 patients (26%) of the validation cohort. Receiver-operator characteristic curve analysis yielded an optimal cutoff point of 130 pg/ml for BNP that was able to discriminate between patients at higher risk in both cohorts. BNP was the strongest independent predictor by multivariate analysis in the derivation set (odds ratio: 6.9 [95% confidence interval: 2.52 to 17.57], p < 0.0001) and the validation set (odds ratio: 6.7 [95% confidence interval: 2.9 to 16.9], p = 0.0001).

Conclusions

Among patients with severe asymptomatic aortic regurgitation and normal left ventricular function, BNP ≥130 pg/ml categorizes a subgroup of patients at higher risk. Because of its incremental prognostic value, we believe BNP assessment should be used in the routine clinical evaluation of these patients.

Key Words

aortic regurgitation
BNP
echocardiography

Abbreviations and Acronyms

AR
aortic regurgitation
BNP
B-type natriuretic peptide
CHF
congestive heart failure
CI
confidence interval
EDD
end-diastolic diameter
EDD/BSA
end-diastolic diameter indexed according to body surface area
EF
ejection fraction
EROA
effective regurgitant orifice area
ESD/BSA
end-systolic diameter indexed according to body surface area
HR
hazard ratio
IDI
integrated discrimination improvement
IQR
interquartile range
LV
left ventricular
LVD
left ventricular dysfunction
LVDSD
left ventricular systolic dysfunction symptoms or death
MET
metabolic equivalent
NT-proBNP
N-terminal pro–B-type natriuretic peptide
OR
odds ratio
PWTd
posterior wall thickness in diastole
PWTs
posterior wall thickness in systole
ROC
receiver-operator characteristic
RV
regurgitant volume
SBP
systolic blood pressure
WS
wall stress

Cited by (0)

All authors have reported that they have no relationships relevant to the contents of this paper to disclose.