Natriuretic Peptides in Common Valvular Heart Disease

Abstract

Valvular heart disease, particularly aortic stenosis and mitral regurgitation, accounts for a large proportion of cardiology practice, and their prevalence is predicted to increase. Management of the asymptomatic patient remains controversial. Biomarkers have been shown to have utility in the management of cardiovascular disease such as heart failure and acute coronary syndromes. In this state-of-the-art review, we examine the current evidence relating to natriuretic peptides as potential biomarkers in aortic stenosis and mitral regurgitation. The natriuretic peptides correlate with measures of disease severity and symptomatic status and also can be used to predict outcome. This review shows that natriuretic peptides have much promise as biomarkers in common valvular heart disease, but the impact of their measurement on clinical practice and outcomes needs to be further assessed in prospective studies before routine clinical use becomes a reality.

How Does the Heart Respond to Aortic Stenosis

“…An elevated B-type natriuretic peptide or elevated LV filling pressure helps to establish a cardiac cause for the patient's dyspnea. 24 The presence of LVH confirms that the patient's LV has responded to a pressure overload and reduced exercise tolerance and a failure of blood pressure to rise with exercise adds additional evidence of the obstructive severity of the patient's aortic stenosis. 25 All of these parameters may be needed to come to a final management decision.…”

Biomarkers in Aortic Stenosis: A Systematic Review

“…45 The exact mechanisms behind the release of these biomarkers and how they relate to LV remodeling are incompletely understood; however, BNP levels have considerable prognostic value in patients with heart failure (HF). 45,46 Reports of NT-proBNP or BNP in AS are summarized in Table 1.…”

Introduction to Aortic Stenosis

“…These include those patients with transaortic jet velocities >4.0 m/s, 46,47 those with heavy valve calcification (who have rapid progression in their disease), 6 those with abnormal exercise test results, 48,49 those with severe LVH, 50 and those with increasing B-type natriuretic peptide. 51,52 Thus, today, AVR may be undertaken in asymptomatic patients with ≥1 of those risk factors when surgery is performed by surgeons in centers with excellent surgical outcomes. 53 At the other end of the AS spectrum is the patient with far-advanced disease, severe symptoms, and decreased LV function.…”