Is there any benefit from evaluation of exercise NT-proBNP concentrations in asymptomatic patients with severe high-gradient aortic stenosis?

Abstract

INTRODUCTION The effect of asymptomatic severe aortic stenosis (ASAS) on N-terminal pro-B-typenatriuretic peptide (NT-proBNP) levels ar rest and during exercise, as well as their relevance for clinicalpractice remain controversial. OBJECTIVES The aim of this study was to test the hypothesis of whether the evaluation of NT-proBNPconcentrations during exercise provides additional information about the severity of aortic stenosis andleft ventricular remodeling in patients with ASAS. PATIENTS AND METHODS A total of 50 patients with ASAS (mean age, 38.4 ±18.1 years) and 21 healthysubjects (mean age, 43.4 ±10.6 years) were enrolled. Rest and exercise echocardiography was performedto evaluate maximum velocity (Vmax), mean aortic gradient (AG), and aortic valve area (AVA). The leftventricular mass index (LVMI) was calculated. NT-proBNP concentrations at rest and during exercisewere assessed, and the difference between the 2 values was calculated (ΔNT-proBNP). RESULTS NT-proBNP and ΔNT-proBNP levels at rest and during exercise were significantly higher in theASAS group compared with the control group. In the ASAS group, NT-proBNP levels at rest significantlycorrelated with LVMI (r = 0.432; P <0.0001), AVA (r = -0.408; P <0.0001), Vmax (r = 0.375; P =0.002), and mean AG (r = 0.257; P = 0.03). NT-proBNP levels during exercise significantly correlatedwith LVMI (r = 0.432; P <0.0001), mean AG (r = 0.401; P = 0.001), and AVA (r = -0.375; P = 0.001).In the multivariate logistic regression model, the factorsindependentlyassociatedwith NT-proBNP bothat rest and during exercise were age, AVA, and LVMI. CONCLUSIONS NT-proBNP levels at rest provide valuable information for identifying patients with moreadvanced left ventricular hypertrophy secondary to severe aortic stenosis. NT-proBNP levels duringexercise do not provide new information on the severity of AS.