Prognostic value of B-type natriuretic peptide in elderly patients with aortic valve stenosis: the COFRASA-GENERAC study.

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.

• Authors: Claire Cimadevilla, Caroline Cueff, Guillaume Hekimian, Monique Dehoux, Laurent Lepage, Bernard Iung, Xavier Duval, Virginie Huart, Florence Tubach, Alec Vahanian, David Messika-Zeitoun
• Journal: Heart (British Cardiac Society) (Heart) Vol. 99 Issue 7 Pg. 461-7 (Apr 2013) ISSN: 1468-201X [Electronic] England
• PMID: 23349346 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Aortic Valve Stenosis (blood, complications, diagnosis, diagnostic imaging, mortality)
• Biomarkers (blood)
• Chi-Square Distribution
• Decision Support Techniques
• Disease Progression
• Disease-Free Survival
• Echocardiography, Doppler
• Female
• Follow-Up Studies
• France
• Heart Failure (etiology)
• Humans
• Kaplan-Meier Estimate
• Linear Models
• Male
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Predictive Value of Tests
• Proportional Hazards Models
• Prospective Studies
• ROC Curve
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Time Factors