09 Jul Biomarker BNP Linked To Severity of Aortic Stenosis
MedicalResearch.com Interview with :
Philippe Pibarot, DVM, PhD, FAHA, FACC, FESC, FASE
Professeur titulaire, Département de Médecine, Université Laval
Professor, Department of Medicine, Laval University
Directeur, Chaire de Recherche du Canada sur les Maladies Valvulaires Cardiaques
Chair, Canada Research Chair in Valvular Heart Diseases
Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec Heart & Lung Institute – Local Y4165
Medical Research: What are the main findings of the study?
Dr. Pibarot: The optimal timing of aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS) remains a matter of debates. Both the American and European guidelines recommend AVR for patients with severe AS who present with symptoms or left ventricular (LV) systolic dysfunction. However, patients with aortic stenosis are often older, less physically active and have more comorbidities, which make the assessment of AS-related symptoms challenging and unreliable. In this study by Capoulade et al, plasma levels of brain natriuretic peptide (BNP) were obtained in 157 patients with severe asymptomatic aortic stenosis and preserved LV ejection fraction at peak of exercise-stress echocardiography. Patients in the upper (>95 pg/ml) and mid (>45 pg/ml) tertiles of exercise BNP respectively had a 5- and 3- fold increase in the risk of events (i.e. AVR or death) compared to those in the lower tertile. Similar results were obtained in the subset of patients with low resting BNP.
Medical Research: What should clinicians and patients take away from your report?
Dr. Pibarot: These findings provide strong impetus for systematic measurement of BNP during exercise test in asymptomatic patients with severe AS. Patients who display a marked increase in BNP during exercise require more frequent and closer clinical and echocardiographic follow-up and may potentially benefit from earlier intervention (i.e. aortic valve replacement)
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Pibarot: Further studies are needed to determine if the present findings obtained with semi-supine exercise test can be transposed to the setting of upright exercise test.
Prognostic value of plasma B-type natriuretic peptide levels after exercise in patients with severe asymptomatic aortic stenosis
Romain Capoulade, Julien Magne, Raluca Dulgheru, Zeineb Hachicha, Jean G Dumesnil, Kim O’Connor, Marie Arsenault, Sébastien Bergeron, Luc A Pierard, Patrizio Lancellotti, Philippe Pibarot
Heart heartjnl-2014-305729Published Online First: 3 July 2014 doi:10.1136/heartjnl-2014-305729