Advertisement

Effect of Balloon Valvuloplasty in Patients With Severe Aortic Stenosis on Levels of N-Terminal Pro-B-Type Natriuretic Peptide

      Plasma levels of brain natriuretic peptide (BNP) have been shown to correlate to aortic stenosis severity and are predictive of symptom development and survival. They also predict postoperative outcomes after valve replacement in patients with aortic stenosis. The early evolution of N-terminal–pro-BNP (NT–pro-BNP) levels after 50 aortic balloon valvuloplasty procedures performed in 45 patients was investigated. The mean NT–pro-BNP concentration decreased from 7,048 ± 7,636 pg/ml at baseline to 5,309 ± 6,150 pg/ml at 1 to 3 days after the procedure (mean difference 1,739 pg/ml, 95% confidence interval 804 to 2,675, p = 0.001). The absolute reduction in NT–pro-BNP levels correlated to the reductions in the maximum and mean transvalvular pressure gradients (on echocardiography: c = 0.57, p = 0.004, and c = 0.54, p = 0.012, respectively; invasively: c = 0.54, p = 0.025, and c = 0.39, p = 0.019). In conclusion, NT–pro-BNP levels decrease early after aortic balloon valvuloplasty in patients with severe aortic stenosis at high surgical risk.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Weber M.
        • Arnold R.
        • Rau M.
        • Elsaesser A.
        • Brandt R.
        • Mitrovic V.
        • Hamm C.
        Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve disease.
        Eur Heart J. 2005; 26: 1023-1030
        • Gerber I.L.
        • Stewart R.A.H.
        • Legget M.E.
        • West T.M.
        • French R.L.
        • Sutton T.M.
        • Yandle T.G.
        • French J.K.
        • Richards A.M.
        • White H.D.
        Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis.
        Circulation. 2003; 107: 1884-1890
        • Bergler-Klein J.
        • Klaar U.
        • Heger M.
        • Rosenhek R.
        • Mundigler G.
        • Gabriel H.
        • Binder T.
        • Pacher R.
        • Maurer G.
        • Baumgartner H.
        Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis.
        Circulation. 2004; 109: 2302-2308
        • Neverdal N.O.
        • Knudsen C.W.
        • Husebye T.
        • Vengen O.A.
        • Pepper J.
        • Lie M.
        • Tønnessen T.
        The effect of aortic valve replacement on plasma B-type natriuretic peptide in patients with severe aortic stenosis—one year follow-up.
        Eur J Heart Fail. 2006; 8: 257-262
        • Bonow R.O.
        • Carabello B.A.
        • Kanu C.
        • de Leon Jr, A.C.
        • Faxon D.P.
        • Freed M.D.
        • Gaasch W.H.
        • Lytle B.W.
        • Nishimura R.A.
        • O'Gara P.T.
        • O'Rourke R.A.
        • Otto C.M.
        • Shah P.M.
        • Shanewise J.S.
        • Smith Jr, S.C.
        • Jacobs A.K.
        • Adams C.D.
        • Anderson J.L.
        • Antman E.M.
        • Faxon D.P.
        • Fuster V.
        • Halperin J.L.
        • Hiratzka L.F.
        • Hunt S.A.
        • Lytle B.W.
        • Nishimura R.
        • Page R.L.
        • Riegel B.
        • American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons
        ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons.
        Circulation. 2006; 114: e84-e231
        • Webb J.G.
        • Pasupati S.
        • Achtem L.
        • Thomson C.R.
        Rapid pacing to facilitate transcatheter prosthetic heart valve implantation.
        Catheter Cardiovasc Interv. 2006; 68: 199-204
        • Klein A.
        • Lee K.
        • Gera A.
        • Ports T.A.
        • Michaels A.D.
        Long-term mortality, cause of death, and temporal trends in complications after percutaneous aortic balloon valvuloplasty for calcific aortic stenosis.
        J Interv Cardiol. 2006; 19: 269-275
        • Shareghi S.
        • Rasouli L.
        • Shavelle D.M.
        • Burstein S.
        • Matthews R.V.
        Current results of balloon aortic valvuloplasty in high-risk patients.
        J Invasive Cardiol. 2007; 19: 1-5
        • Pedersen W.R.
        • Klaassen P.J.
        • Boisjolie C.R.
        • Pierce T.A.
        • Harris K.M.
        • Lesser J.R.
        • Hara H.
        • Mooney M.R.
        • Graham K.J.
        • Kshettry V.R.
        • Goldenberg I.F.
        • Priztker M.R.
        • Van Tassel R.A.
        • Schwartz R.S.
        Feasibility of transcatheter intervention for severe aortic stenosis in patients ≥90 years of age: aortic valvuloplasty revisited.
        Catheter Cardiovasc Interv. 2007; 70: 149-154
        • Sagnella G.A.
        Measurement and significance of circulating natriuretic peptides in cardiovascular disease.
        Clin Sci. 1998; 95: 519-529
        • Hall C.
        Essential biochemistry and physiology of (NT-pro)BNP.
        Eur J Heart Fail. 2004; 6: 257-260
        • Ikeda T.
        • Matsuda K.
        • Itoh H.
        • Shirakami G.
        • Miyamoto Y.
        • Yoshimasa T.
        • Nakao K.
        • Ban T.
        Plasma levels of brain and atrial natriuretic peptides elevate in proportion to left ventricular end-systolic wall stress in patients with aortic stenosis.
        Am Heart J. 1997; 133: 307-314
        • Kupari M.
        • Turto H.
        • Lommi J.
        • Mäkijärvi M.
        • Parikka H.
        Transcardiac gradients of N-terminal B-type natriuretic peptide in aortic valve stenosis.
        Eur J Heart Fail. 2005; 7: 809-814
        • Bergler-Klein J.
        • Mundigler G.
        • Pibarot P.
        • Burwash I.G.
        • Dumesnil J.G.
        • Blais C.
        • Fuchs C.
        • Mohty D.
        • Beanlands R.S.
        • Hachicha Z.
        • Walter-Publig N.
        • Rader F.
        • Baumgartner H.
        B-type natriuretic peptide in low-flow, low-gradient aortic stenosis.
        Circulation. 2007; 115: 2848-2855
        • Hara H.
        • Pedersen W.R.
        • Ladich E.
        • Mooney M.
        • Virmani R.
        • Nakamura M.
        • Feldman T.
        • Schwartz R.S.
        Percutaneous balloon aortic valvuloplasty revisited: time for a renaissance?.
        Circulation. 2007; 115: 334-338
        • Descoutures F.
        • Himbert D.
        • Lepage L.
        • Iung B.
        • Détaint D.
        • Tchetche D.
        • Brochet E.
        • Castier Y.
        • Depoix J.P.
        • Nataf P.
        • Vahanian A.
        Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly.
        Eur Heart J. 2008; 29: 1410-1417
        • Lieberman E.B.
        • Wilson J.S.
        • Harrison J.K.
        • Pieper K.S.
        • Kisslo K.B.
        • Lowe J.
        • Douglas Jr, J.
        • Van Trigt P.
        • Glower D.D.
        • Davidson C.J.
        Aortic valve replacement in adults after balloon aortic valvuloplasty.
        Circulation. 1994; 90: II205-II208
        • Agarwal A.
        • Kini A.
        • Attanti S.
        • Lee P.C.
        • Ashtiani R.
        • Steinheimer A.M.
        • Moreno P.R.
        • Sharma S.K.
        Results of repeat balloon valvuloplasty for treatment of aortic stenosis in patients aged 59 to 104 years.
        Am J Cardiol. 2005; 95: 43-47