ID 113031
Title Alternative
BNP and Strain in Aortic Stenosis
Author
Goodman, Andrew Cleveland Clinic
Popovic, Zoran B. Cleveland Clinic
Parikh, Roosha Cleveland Clinic
Barr, Tyler Cleveland Clinic
Sabik, Joseph F. Cleveland Clinic
Rodriguez, L. Leonardo Cleveland Clinic
Svensson, Lars G. Cleveland Clinic
Griffin, Brian P. Cleveland Clinic
Desai, Milind Y. Cleveland Clinic
Keywords
aortic stenosis
brain natriuretic peptide
global longitudinal strain
Content Type
Journal Article
Description
Background
In aortic stenosis (AS), symptoms and left ventricular (LV) dysfunction represent a later disease state, and objective parameters that identify incipient LV dysfunction are needed. We sought to determine prognostic utility of brain natriuretic peptide (BNP) and left ventricular global longitudinal strain (LV‐GLS) in patients with aortic valve area <1.3 cm2.
Methods and Results
Five‐hundred and thirty‐one patients between January 2007 and December 2008 with aortic valve area <1.3 cm2(86% with aortic valve area ≤1.1 cm2) and left ventricular ejection fraction ≥50% who had BNP drawn ≤90 days from initial echo were included. Society of Thoracic Surgeons (STS) score and mortality were recorded. Mean STS score, glomerular filtration rate, and median BNP were 11±5, 73±35 mL/min per 1.73 m , and 141 (60–313) pg/mL, respectively; 78% were in New York Heart Association class ≥II. Mean LV‐stroke volume index (LV‐SVI) and LV‐GLS were 39±10 mL/m2 and −13.9±3%. At 4.7±2 years, 405 patients (76%) underwent aortic valve replacement; 161 died (30%). On multivariable survival analysis, age (hazard ratio [HR] 1.46), New York Heart Association class (HR1.27), coronary artery disease (HR 1.72), decreasing glomerular filtration rate (HR 1.15), increasing BNP (HR 1.16), worsening LV‐GLS (HR 1.13) and aortic valve replacement (time dependent) (HR 0.34) predicted survival (all P<0.01). For mortality, the c‐statistic incrementally increased as follows (all P<0.01): STS score (0.60 [0.58–0.64]), STS score+BNP (0.67 [0.62–0.70]), and STS score+BNP+LV‐GLS (0.74 [0.68–0.78]).
Conclusions
In normal LVEF patients with significant aortic stenosis, BNP and LV‐GLS provide incremental (additive not duplicative) prognostic information over established predictors, suggesting that both play a synergistic role in defining outcomes.
Journal Title
Journal of the American Heart Association
ISSN
20479980
Publisher
The American Heart Association|Wiley
Volume
5
Issue
1
Start Page
e002561
Published Date
2016-01-05
Rights
© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License(https://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
EDB ID
DOI (Published Version)
URL ( Publisher's Version )
FullText File
language
eng
TextVersion
Publisher
departments
University Hospital