Prognostic value of B-type natriuretic peptide in elderly patients with aortic valve stenosis: the COFRASA–GENERAC study. Issue 7 (24th January 2013)

• Record Type: Journal Article
• Authors: Cimadevilla, Claire; Cueff, Caroline; Hekimian, Guillaume; Dehoux, Monique; Lepage, Laurent; Iung, Bernard; Duval, Xavier; Huart, Virginie; Tubach, Florence; Vahanian, Alec; Messika-Zeitoun, David
• Is Part Of: Heart. Volume 99:Issue 7(2013)
• Page Start: 461
• Page End: 467
• Publication Date: 2013-01-24
• Subjects: Valvular Disease; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2012-303284
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: Previous studies suggested an independent prognostic value of B-type natriuretic peptide (BNP) in aortic valve stenosis (AS) but were impeded by small sample sizes and inclusion of relatively selected young patients. We aimed to evaluate the relationship among N-terminal fragment of proBNP (Nt-proBNP), AS severity, symptoms and outcome in a large cohort of elderly patients with AS. Design: Observational cohort study, COhorte Française de Retrecissement Aortique du Sujet Agé (clinicalTrial.gov number-NCT00338676 ) and GENEtique du Retrecissement Aortique (clinicalTrial.gov number-NCT00647088 ). Setting: Single-centre study. Patients: Patients older than 70 years with at least mild AS. Interventions: None. Measurements: A comprehensive clinical, biological and echocardiographic evaluation was performed at study entry. Asymptomatic patients were prospectively followed on a 6-months basis and AS-related events (sudden death, congestive heart failure or new onset of AS-related symptoms) collected. Results: We prospectively enrolled 361 patients (79±6 years, 230 severe AS). Nt-proBNP increased with the grade of AS severity and the NYHA class (all p<0.0001) but there was an important overlap between grades/classes. Consequently, diagnostic value of Nt-proBNP for the diagnosis of severe symptomatic AS was only modest (area under the curve of the receiver operator characteristic analysis=0.73). At 2 years, 28 AS-related events occurred among 142 asymptomatic patients prospectively followed. Nt-proBNP was associated with outcome in univariate analysis (p=0.04) but not after adjustment for age, gender and AS severity (p=0.40). Conclusions: The present study clearly highlights the limitations of Nt-proBNP for the evaluation and management of AS patients. Our results suggest that Nt-proBNP should be considered cautiously, at least as a single criterion, in the decision-making process of AS patients especially in the elderly population.