Plasma levels of brain and atrial natriuretic peptides elevate in proportion to left ventricular end-systolic wall stress in patients with aortic stenosis

Ikeda, Tadashi; Matsuda, Katsuhiko; Itoh, Hiroshi; Shirakami, Gotaro; Miyamoto, Yoshihiro; Yoshimasa, Takaaki; Nakao, Kazuwa; Ban, Toshihiko

doi:10.1016/s0002-8703(97)70225-4

Cited by 110 publications

(79 citation statements)

References 24 publications

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“…Increased LV wall stress has been proposed as a stimulus for the release of natriuretic peptides in aortic stenosis. 25 In this study, there was a weaker but significant correlation between wall stress and natriuretic peptide levels, and wall stress was higher in symptomatic compared with asymptomatic patients. The development of diastolic dysfunction is another plausible explanation for symptom onset.…”

Section: Discussionmentioning

confidence: 48%

Increased Plasma Natriuretic Peptide Levels Reflect Symptom Onset in Aortic Stenosis

et al. 2003

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Background-The onset of symptoms is a critical point in the natural history of aortic stenosis and the cardinal indication for valve replacement. This study assessed the associations between natriuretic peptide levels, disease severity, and cardiac symptoms in aortic stenosis. Methods and Results-Seventy-four patients with isolated aortic stenosis underwent independent assessment of symptoms, transthoracic echocardiography, and measurement of plasma levels of atrial natriuretic peptide, brain natriuretic peptide (BNP), and N-BNP. Natriuretic peptide levels were also measured in 100 clinically normal control subjects. The aortic valve area was smaller in symptomatic patients (nϭ45) than in asymptomatic patients (nϭ29; mean, 0.71Ϯ0.23 cm 2 and 0.99Ϯ0.31 cm 2 , respectively; PϽ0.0001). Plasma natriuretic peptide levels were higher in symptomatic patients than in asymptomatic patients (for N-BNP: median, 112 versus 33 pmol/L; interquartile range, 70 to 193 versus 16 to 58 pmol/L, respectively; Pϭ0.0002). After adjustment for age, sex, serum creatinine, aortic valve area, and left ventricular ejection fraction, N-BNP levels were 1.74 times higher (95% confidence interval, 1.12 to 2.69) for symptomatic than asymptomatic patients with aortic stenosis (Pϭ0.014). Natriuretic peptide levels increased with the New York Heart Association class (for N-BNP median values were 13, 34, 105, and 202 pmol/L for normal control subjects, class I, class II, and class III/IV patients, respectively; interquartile ranges for the same patients were 8 to 21, 16 to 58, 57 to 159, and 87 to 394 pmol/L; PϽ0.0001). Similar associations were observed for BNP and atrial natriuretic peptide. Conclusions-Plasma natriuretic peptide levels are elevated in symptomatic patients with aortic stenosis. Measurement of natriuretic peptides may complement clinical and echocardiographic evaluation of patients with aortic stenosis.

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Section: Discussionmentioning

confidence: 48%

Increased Plasma Natriuretic Peptide Levels Reflect Symptom Onset in Aortic Stenosis

et al. 2003

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“…Increased wall stress and myocardial stretch have been shown to release BNP, which has been referred to as the only "true" ventricular hormone, in various cardiac entities 26 -28 and also in previous studies of AS. 14,16 Patients with TS AS had indeed higher gradients, whereas EF was similar in both groups. Because BNP increases with the severity of LV damage of any cause, it is not surprising that the overlap of BNP levels between PS AS and TS AS was too extensive to allow their differentiation in individual patients.…”

Section: Bnp In Low-flow Low-gradient Aortic Stenosismentioning

confidence: 79%

B-Type Natriuretic Peptide in Low-Flow, Low-Gradient Aortic Stenosis

et al. 2007

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Background-The prognostic value of B-type natriuretic peptide (BNP) is unknown in low-flow, low-gradient aortic stenosis (AS). We sought to evaluate the relationship between AS and rest, stress hemodynamics, and clinical outcome. Methods and Results-BNP was measured in 69 patients with low-flow AS (indexed effective orifice area Ͻ0.6 cm 2 /m 2 , mean gradient Յ40 mm Hg, left ventricular ejection fraction Յ40%). All patients underwent dobutamine stress echocardiography and were classified as truly severe or pseudosevere AS by their projected effective orifice area at normal flow rate of 250 mL/s (effective orifice area Յ1.0 cm 2 or Ͼ1.0 cm 2 ). BNP was inversely related to ejection fraction at rest (Spearman correlation coefficient r s ϭϪ0.59, PϽ0.0001) and at peak stress (r s ϭϪ0.51, PϽ0.0001), effective orifice area at rest (r s ϭϪ0.50, PϽ0.0001) and at peak stress (r s ϭϪ0.46, Pϭ0.0002), and mean transvalvular flow (r s ϭϪ0.31, Pϭ0.01). BNP was directly related to valvular resistance (r s ϭ0.42, Pϭ0.0006) and wall motion score index (r s ϭ0.36, Pϭ0.004). BNP was higher in 29 patients with truly severe AS versus 40 with pseudosevere AS (median, 743 pg/mL [Q1, 471; Q3, 1356] versus 394 pg/mL [Q1, 191 to Q3, 906], Pϭ0.012). BNP was a strong predictor of outcome. In the total cohort, cumulative 1-year survival of patients with BNP Ն550 pg/mL was only 47Ϯ9% versus 97Ϯ3% with BNP Ͻ550 (PϽ0.0001). In 29 patients who underwent valve replacement, postoperative 1-year survival was also markedly lower in patients with BNP Ն550 pg/mL (53Ϯ13% versus 92Ϯ7%). Conclusions-BNP is significantly higher in truly severe than pseudosevere low-gradient AS and predicts survival of the whole cohort and in patients undergoing valve replacement.

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“…Recent studies measuring serum neurohormone levels, such as brain natriuretic peptide (BNP), demonstrate an association of increased levels with disease severity. 81,82 There is a progressive association of serum BNP with the severity of aortic stenosis and left ventricular dysfunction ( Figure 6). Asymptomatic patients with more hemodynamically significant aortic valve disease had higher serum BNP levels, which suggests that BNP may represent a marker of disease severity and may potentially serve to discriminate between normal exercise tolerance and true early symptoms of heart failure.…”

Section: Symptom Onset In Adults With Aortic Stenosismentioning

confidence: 99%