Natriuretic peptides in patients with aortic stenosis

Czech version

Authors: I. Riečanský ^1,2; B. Líška ²; M. Vršanský ²; I. Pecháň ³; K. Dáňová ³
Authors‘ workplace: Katedra kardiológie a angiológie Fakulty zdravotníckych špecializačných štúdií Slovenskej zdravotníckej univerzity Bratislava, Slovenská republika, prednosta prof. MUDr. Róbert Hatala, PhD. ¹; Kardiologická klinika Národného ústavu srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika, prednosta prof. MUDr. Róbert Hatala, PhD. ²; Oddelenie laboratórnej medicíny Národného ústavu srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika, prednostka MUDr. Katarína Daňová, PhD. ³
Published in: Vnitř Lék 2010; 56(7): 715-720
Category: 80th Birthday - Jaroslava Blahoše, MD, DrSc.

Overview

Introduction:
The aim of this research was to, in patients with severe (tight) aortic stenosis (AoS), evaluate a) an association between clinical and some haemodynamic characteristics and natriuretic peptides (ANP, BNP) concentrations and b) usefulness of these hormones in the decision making on the next therapeutic steps.

Methods:
Echocardiography and 6-minut exertion walking test were performed in 23 consecutive patients (12 men, 11 women; age 67 ± 7 years) and 20 controls together with ANP and BNP measurements from three plasma samples before, immediately after and 20 minutes after the exertion test.

Results:
There was high inter‑individual variability in the ANP and BNP concentrations in patients with AoS. All ANP and BNP were significantly higher than in the controls (ANP 1, 2, 3, p < 0.001; BNP 1, 2, 3, p < 0.001). Only the ANP levels increased significantly after the exercise (ANP 1 vs. ANP 2 = 0.011; ANP 2 vs. ANP 3 p = 0.037). We identified significant correlations between aortic peak gradient and BNP 1, 2 (r = 0.821, p < 0.001) and ANP 1, with BNP correlations being stronger. We did not find any correlations with aortic valve area and the left ventricle mass. The hormone levels were non‑significantly increased depending on NYHA classification. Exercise did not improve validity of ANP and BNP measurement. Their values had high sensitivity but low specificity in detecting critical AoS.

Conclusion:
ANP and mainly BNP helped to exclude severe AoS but they were not useful in detecting lower, borderline gradients. We did not prove ANP and BNP to be significant factors in decision making about the timing of AoS surgery.

Key words:
natriuretic peptides – ANP, BNP – aortic stenosis

Sources

1. Kangawa L, Matsuo H. Purification and complete amino acid sequence of alfa‑human atrial natriuretic peptide. Biochem Biophys Res Commun 1984; 118: 131–139.

2. Sudoh T, Minamino N, Kangawa L et al. A new natriuretic peptide in porcine brain. Nature 1988; 332: 78–81.

3. Stein BC, Levin RI. Natriuretic peptides: physiology, therapeutic potential and risk stratification in ischemic heart disease. Am Heart J 1998; 135: 914–923.

4. Lazúrová I, Lichardus B. Endokrinné srdce. In: Kreze A, Langer P, Klimeš I et al (eds). Všeobecná a klinická endokrinológia. Bratislava: Academic Electronic Press 2004: 771–776.

5. McMurray J, Komajda M, Anker S et al. Heart failure: eoidemiology, pathophysiology and diagnosis. In: Camm AJ, Lüscher TF, Serruys PW (eds). The ESC textbook of cardiovascular medicine. Malden, Oxford, Carlton: Blackwell Publishing 2006: 685–719.

6. Morrison K, Harrison A, Krishnaswamy G et al. Utility of a rapid B‑natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting dyspnea. J Am Coll Cardiol 2002; 39: 202–209.

7. Devereux RB, Alonso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy: comparison with necropsy findings. Am J Cardiol 1986; 57: 450–458.

8. Prasad N, Bridges AB, Lang CC et al. Brain natriuretic peptide concentrations in patients with aortic stenosis. Am Heart J 1997; 133: 477–479.

9. Talwar S, Downie PF, Squire IB et al. Plasma N‑terminal pro BNP and cardiotrophin‑1 are elevated in aortic stenosis. Eur J Heart Fail 2001; 3: 15–19.

10. Qi W, Mathisen P, Kjekshus J et al. Natriuretic peptides in patients with aortic stenosis. Am Heart J 2001; 142: 725–732.

11. Bergler‑Klein J, Klaar U, Heger M et al. Natriuretic peptides predict symptom – free survival and postoperative outcome in severe aortic stenosis. Circulation 2004; 109: 2302–2308.

12. Weber M, Arnold R, Rau M et al. Relation of N‑terminal pro B‑type natriuretic peptide to progression of aortic valve disease. Eur Heart J 2005; 26: 1023–1030.

13. Weber M, Arnold R, Rau M et al. Relation of N‑terminal pro B type natriuretic peptide to severity of valvular aortic stenosis. Am J Cardiol 2004; 94: 740–745.

14. Bergler‑Klein J, Mundigler G, Pibarot P et al. B‑type natriuretic peptide in low‑flow, low‑gradient aortic stenosis: relationship to hemodynamics and clinical outcome: results from the multicenter truly or pseudo‑severe aortic stenosis (TOPAS) study. Circulation 2007; 115: 2848–2855.

15. Ikeda T, Matsuda K, Itoh H et al. 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.

16. Cemri M, Arslan U, Kocaman S et al. Relationship between N‑terminal pro‑B type natriuretic peptide and extensive echocardiographic parameters in mild to moderate aortic stenosis. J Postgrad Med 2008; 54: 12–16.

17. Gerber IL, Steward RA, Legget ME et al. Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis. Circulation 2003; 107: 1884–1890.

18. Lim P, Monin JL, Monchi M et al. Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B‑type natriuretic peptide. Eur Heart J 2004; 25: 2048–2053.

19. Gerber IL, Legget ME, West TM et al. Usefulness of serial measurement of N‑Terminal Pro‑Brain natriuretic peptide plasma levels in asymptomatic patients with aortic stenosis to predict symptomatic deterioration. Am J Cardiol 2005; 95: 898–901.

20. Antonini‑Canterin F, Popescu BA, Popescu AC et al. Heart failure in patients with aortic stenosis: clinical and prognostic significance of carbohydrate antigen 125 and brain natriuretic peptide measurement. Int J Cardiol 2008; 128: 406‑412.

21. Pedrazzini GB, Masson S, Latini R et al. Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in‑hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosis. Am J Cardiol 2008; 102: 749–754.

22. Wagner JA, Störk S, Weidemann F et al. Natriuretic peptides and myocardial oxygen supply – to demand ratio in patients with aortic stenosis. Eur J Clin Invest 2007; 37: 463–471.

23. Hrudová J, Linhart A, Vondráček V et al. Humorální profil pacientů s těsnou aortální stenózou. Čas Lék Čes 2000; 139: 74–78.

24. Monin JL, Lancellotti P, Monchi M et al. Risk score for predicting outcome in patients with asymptomatic aortic stenosis. Circulation 2009; 120: 69–75.

25. Amato MC, Moffa PJ, Werner KF et al. Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing. Heart 2001; 86: 381–386.

26. Van Pelt NC, Kerr AJ, Legget ME et al. Increased B‑type natriuretic peptide is associated with an abnormal blood pressure response to exercise in asymptomatic aortic stenosis. Int J Cardiol 2008; 127: 313–320.

27. Redfield MM, Rodeheffer RJ, Jacobsen SJ et al. Plasma brain natriuretic peptide concentration: impact of age and gender. J Am Coll Cardiol 2002; 40: 976‑982.

28. Wang TJ, Larson MG, Levy D et al. Impact of age and sex on plasma natriuretic peptide levels in healthy adults. Am J Cardiol 2002; 90: 254–258.