Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis
The prognostic value of natriuretic peptides in aortic stenosis (AS) remains unknown. B-type natriuretic peptide (BNP), N-terminal BNP (NtBNP), and N-terminal atrial natriuretic peptide (NtANP) were determined in 130 patients with severe AS (mean age, 70+/-12 years; mean gradient, 64+/-21 mm Hg; val...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2004-05, Vol.109 (19), p.2302-2308 |
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| creator | BERGLER-KLEIN, Jutta KLAAR, Ursula HEGER, Maria ROSENHEK, Raphael MUNDIGLER, Gerald GABRIEL, Harald BINDER, Thomas PACHER, Richard MAURER, Gerald BAUMGARTNER, Helmut |
| description | The prognostic value of natriuretic peptides in aortic stenosis (AS) remains unknown.
B-type natriuretic peptide (BNP), N-terminal BNP (NtBNP), and N-terminal atrial natriuretic peptide (NtANP) were determined in 130 patients with severe AS (mean age, 70+/-12 years; mean gradient, 64+/-21 mm Hg; valve area, 0.64+/-0.15 cm2) who were followed up for 377+/-150 days. Natriuretic peptides increased with NYHA class and with decreasing ejection fraction (EF). Even asymptomatic patients frequently had elevated neurohormones. Asymptomatic patients who developed symptoms during follow-up had higher BNP and NtBNP levels at entry compared with those remaining asymptomatic (median for NtBNP, 131 pmol/L [interquartile range, 50 to 202 pmol/L] versus 31 pmol/L [range, 19 to 56 pmol/L]; P |
| doi_str_mv | 10.1161/01.cir.0000126825.50903.18 |
| format | Article |
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B-type natriuretic peptide (BNP), N-terminal BNP (NtBNP), and N-terminal atrial natriuretic peptide (NtANP) were determined in 130 patients with severe AS (mean age, 70+/-12 years; mean gradient, 64+/-21 mm Hg; valve area, 0.64+/-0.15 cm2) who were followed up for 377+/-150 days. Natriuretic peptides increased with NYHA class and with decreasing ejection fraction (EF). Even asymptomatic patients frequently had elevated neurohormones. Asymptomatic patients who developed symptoms during follow-up had higher BNP and NtBNP levels at entry compared with those remaining asymptomatic (median for NtBNP, 131 pmol/L [interquartile range, 50 to 202 pmol/L] versus 31 pmol/L [range, 19 to 56 pmol/L]; P<0.001). Symptom-free survival at 3, 6, 9, and 12 months for patients with NtBNP <80 versus > or =80 pmol/L was 100%, 88+/-7%, 88+/-7%, and 69+/-13% compared with 92+/-8%, 58+/-14%, 35+/-15%, and 18+/-15%, respectively (P<0.001). Seventy-nine patients eventually underwent surgery because of symptoms. Considering preoperative neurohormone levels, age, NYHA class, aortic valve area, EF, and presence of coronary artery disease, we found that neurohormones, EF, and NYHA class predicted survival; neurohormones predicted postoperative symptomatic status; and neurohormones and preoperative EF predicted postoperative EF. However, by multivariate analysis, NtBNP was the only independent predictor of outcome.
In severe AS, natriuretic peptides provide important prognostic information beyond clinical and echocardiographic evaluation. NtBNP independently predicts symptom-free survival, and preoperative NtBNP independently predicts postoperative outcome with regard to survival, symptomatic status, and left ventricular function. Thus, neurohormones may gain particular importance for timing of surgery in asymptomatic severe AS.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.cir.0000126825.50903.18</identifier><identifier>PMID: 15117847</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve Stenosis - blood ; Aortic Valve Stenosis - complications ; Aortic Valve Stenosis - diagnostic imaging ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - surgery ; Atrial Natriuretic Factor - blood ; Biological and medical sciences ; Biomarkers ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Disease Progression ; Disease-Free Survival ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Dyspnea - etiology ; Female ; Heart Failure - blood ; Heart Failure - diagnostic imaging ; Heart Failure - etiology ; Heart Valve Prosthesis Implantation - statistics & numerical data ; Humans ; Life Tables ; Male ; Medical sciences ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Nerve Tissue Proteins - blood ; Peptide Fragments - blood ; Prognosis ; Prospective Studies ; Protein Precursors - blood ; Severity of Illness Index ; Single-Blind Method ; Stroke Volume ; Treatment Outcome ; Ultrasonography</subject><ispartof>Circulation (New York, N.Y.), 2004-05, Vol.109 (19), p.2302-2308</ispartof><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-426538e0f124ed0f99959c1f91630b8cc0295ac06ea0017c7090d207c89b54a93</citedby><cites>FETCH-LOGICAL-c508t-426538e0f124ed0f99959c1f91630b8cc0295ac06ea0017c7090d207c89b54a93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15815524$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15117847$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>BERGLER-KLEIN, Jutta</creatorcontrib><creatorcontrib>KLAAR, Ursula</creatorcontrib><creatorcontrib>HEGER, Maria</creatorcontrib><creatorcontrib>ROSENHEK, Raphael</creatorcontrib><creatorcontrib>MUNDIGLER, Gerald</creatorcontrib><creatorcontrib>GABRIEL, Harald</creatorcontrib><creatorcontrib>BINDER, Thomas</creatorcontrib><creatorcontrib>PACHER, Richard</creatorcontrib><creatorcontrib>MAURER, Gerald</creatorcontrib><creatorcontrib>BAUMGARTNER, Helmut</creatorcontrib><title>Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>The prognostic value of natriuretic peptides in aortic stenosis (AS) remains unknown.
B-type natriuretic peptide (BNP), N-terminal BNP (NtBNP), and N-terminal atrial natriuretic peptide (NtANP) were determined in 130 patients with severe AS (mean age, 70+/-12 years; mean gradient, 64+/-21 mm Hg; valve area, 0.64+/-0.15 cm2) who were followed up for 377+/-150 days. Natriuretic peptides increased with NYHA class and with decreasing ejection fraction (EF). Even asymptomatic patients frequently had elevated neurohormones. Asymptomatic patients who developed symptoms during follow-up had higher BNP and NtBNP levels at entry compared with those remaining asymptomatic (median for NtBNP, 131 pmol/L [interquartile range, 50 to 202 pmol/L] versus 31 pmol/L [range, 19 to 56 pmol/L]; P<0.001). Symptom-free survival at 3, 6, 9, and 12 months for patients with NtBNP <80 versus > or =80 pmol/L was 100%, 88+/-7%, 88+/-7%, and 69+/-13% compared with 92+/-8%, 58+/-14%, 35+/-15%, and 18+/-15%, respectively (P<0.001). Seventy-nine patients eventually underwent surgery because of symptoms. Considering preoperative neurohormone levels, age, NYHA class, aortic valve area, EF, and presence of coronary artery disease, we found that neurohormones, EF, and NYHA class predicted survival; neurohormones predicted postoperative symptomatic status; and neurohormones and preoperative EF predicted postoperative EF. However, by multivariate analysis, NtBNP was the only independent predictor of outcome.
In severe AS, natriuretic peptides provide important prognostic information beyond clinical and echocardiographic evaluation. NtBNP independently predicts symptom-free survival, and preoperative NtBNP independently predicts postoperative outcome with regard to survival, symptomatic status, and left ventricular function. Thus, neurohormones may gain particular importance for timing of surgery in asymptomatic severe AS.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve Stenosis - blood</subject><subject>Aortic Valve Stenosis - complications</subject><subject>Aortic Valve Stenosis - diagnostic imaging</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Atrial Natriuretic Factor - blood</subject><subject>Biological and medical sciences</subject><subject>Biomarkers</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Disease Progression</subject><subject>Disease-Free Survival</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Dyspnea - etiology</subject><subject>Female</subject><subject>Heart Failure - blood</subject><subject>Heart Failure - diagnostic imaging</subject><subject>Heart Failure - etiology</subject><subject>Heart Valve Prosthesis Implantation - statistics & numerical data</subject><subject>Humans</subject><subject>Life Tables</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Nerve Tissue Proteins - blood</subject><subject>Peptide Fragments - blood</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Protein Precursors - blood</subject><subject>Severity of Illness Index</subject><subject>Single-Blind Method</subject><subject>Stroke Volume</subject><subject>Treatment Outcome</subject><subject>Ultrasonography</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkV-L1TAQxYMo7nX1K0gQ9K01kzRt4ptc_LOwKIg-h9x0CpG2qZn0wn57s-6FdV6Ggd-c4Zxh7A2IFqCH9wLaEHMraoHsjdStFlaoFswTdgAtu6bTyj5lhwrYZlBSXrEXRL_r2KtBP2dXoAEG0w0HNn3zJcc9Y4mBb7iVOCLxLeMYQ-F0t2wlLc2UETnt-RzPfuZ-HfmWqKQNsy_xjDztJaQFeVw54Rkzcp_yvSIVXBNFesmeTX4mfHXp1-zX508_j1-b2-9fbo4fb5ughSlNJ3utDIoJZIejmKy12gaYLPRKnEwIQlrtg-jRV-9DGKrvUYohGHvSnbfqmr170N1y-rMjFbdECjjPfsW0kxvAql6LroIfHsCQE1HGyW05Lj7fORDuPmUnwB1vfrjHlN2_lB2Yuvz6cmU_LTg-rl5ircDbC-Ap-HnKfg2R_uMM6Pon9Rf6S4eD</recordid><startdate>20040518</startdate><enddate>20040518</enddate><creator>BERGLER-KLEIN, Jutta</creator><creator>KLAAR, Ursula</creator><creator>HEGER, Maria</creator><creator>ROSENHEK, Raphael</creator><creator>MUNDIGLER, Gerald</creator><creator>GABRIEL, Harald</creator><creator>BINDER, Thomas</creator><creator>PACHER, Richard</creator><creator>MAURER, Gerald</creator><creator>BAUMGARTNER, Helmut</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040518</creationdate><title>Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis</title><author>BERGLER-KLEIN, Jutta ; KLAAR, Ursula ; HEGER, Maria ; ROSENHEK, Raphael ; MUNDIGLER, Gerald ; GABRIEL, Harald ; BINDER, Thomas ; PACHER, Richard ; MAURER, Gerald ; BAUMGARTNER, Helmut</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-426538e0f124ed0f99959c1f91630b8cc0295ac06ea0017c7090d207c89b54a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve Stenosis - blood</topic><topic>Aortic Valve Stenosis - complications</topic><topic>Aortic Valve Stenosis - diagnostic imaging</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Atrial Natriuretic Factor - blood</topic><topic>Biological and medical sciences</topic><topic>Biomarkers</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Disease Progression</topic><topic>Disease-Free Survival</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Dyspnea - etiology</topic><topic>Female</topic><topic>Heart Failure - blood</topic><topic>Heart Failure - diagnostic imaging</topic><topic>Heart Failure - etiology</topic><topic>Heart Valve Prosthesis Implantation - statistics & numerical data</topic><topic>Humans</topic><topic>Life Tables</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Nerve Tissue Proteins - blood</topic><topic>Peptide Fragments - blood</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Protein Precursors - blood</topic><topic>Severity of Illness Index</topic><topic>Single-Blind Method</topic><topic>Stroke Volume</topic><topic>Treatment Outcome</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BERGLER-KLEIN, Jutta</creatorcontrib><creatorcontrib>KLAAR, Ursula</creatorcontrib><creatorcontrib>HEGER, Maria</creatorcontrib><creatorcontrib>ROSENHEK, Raphael</creatorcontrib><creatorcontrib>MUNDIGLER, Gerald</creatorcontrib><creatorcontrib>GABRIEL, Harald</creatorcontrib><creatorcontrib>BINDER, Thomas</creatorcontrib><creatorcontrib>PACHER, Richard</creatorcontrib><creatorcontrib>MAURER, Gerald</creatorcontrib><creatorcontrib>BAUMGARTNER, Helmut</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>BERGLER-KLEIN, Jutta</au><au>KLAAR, Ursula</au><au>HEGER, Maria</au><au>ROSENHEK, Raphael</au><au>MUNDIGLER, Gerald</au><au>GABRIEL, Harald</au><au>BINDER, Thomas</au><au>PACHER, Richard</au><au>MAURER, Gerald</au><au>BAUMGARTNER, Helmut</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2004-05-18</date><risdate>2004</risdate><volume>109</volume><issue>19</issue><spage>2302</spage><epage>2308</epage><pages>2302-2308</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>The prognostic value of natriuretic peptides in aortic stenosis (AS) remains unknown.
B-type natriuretic peptide (BNP), N-terminal BNP (NtBNP), and N-terminal atrial natriuretic peptide (NtANP) were determined in 130 patients with severe AS (mean age, 70+/-12 years; mean gradient, 64+/-21 mm Hg; valve area, 0.64+/-0.15 cm2) who were followed up for 377+/-150 days. Natriuretic peptides increased with NYHA class and with decreasing ejection fraction (EF). Even asymptomatic patients frequently had elevated neurohormones. Asymptomatic patients who developed symptoms during follow-up had higher BNP and NtBNP levels at entry compared with those remaining asymptomatic (median for NtBNP, 131 pmol/L [interquartile range, 50 to 202 pmol/L] versus 31 pmol/L [range, 19 to 56 pmol/L]; P<0.001). Symptom-free survival at 3, 6, 9, and 12 months for patients with NtBNP <80 versus > or =80 pmol/L was 100%, 88+/-7%, 88+/-7%, and 69+/-13% compared with 92+/-8%, 58+/-14%, 35+/-15%, and 18+/-15%, respectively (P<0.001). Seventy-nine patients eventually underwent surgery because of symptoms. Considering preoperative neurohormone levels, age, NYHA class, aortic valve area, EF, and presence of coronary artery disease, we found that neurohormones, EF, and NYHA class predicted survival; neurohormones predicted postoperative symptomatic status; and neurohormones and preoperative EF predicted postoperative EF. However, by multivariate analysis, NtBNP was the only independent predictor of outcome.
In severe AS, natriuretic peptides provide important prognostic information beyond clinical and echocardiographic evaluation. NtBNP independently predicts symptom-free survival, and preoperative NtBNP independently predicts postoperative outcome with regard to survival, symptomatic status, and left ventricular function. Thus, neurohormones may gain particular importance for timing of surgery in asymptomatic severe AS.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>15117847</pmid><doi>10.1161/01.cir.0000126825.50903.18</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Valve Stenosis - blood Aortic Valve Stenosis - complications Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - mortality Aortic Valve Stenosis - surgery Atrial Natriuretic Factor - blood Biological and medical sciences Biomarkers Blood and lymphatic vessels Cardiology. Vascular system Disease Progression Disease-Free Survival Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Dyspnea - etiology Female Heart Failure - blood Heart Failure - diagnostic imaging Heart Failure - etiology Heart Valve Prosthesis Implantation - statistics & numerical data Humans Life Tables Male Medical sciences Middle Aged Natriuretic Peptide, Brain - blood Nerve Tissue Proteins - blood Peptide Fragments - blood Prognosis Prospective Studies Protein Precursors - blood Severity of Illness Index Single-Blind Method Stroke Volume Treatment Outcome Ultrasonography |
| title | Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis |
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