Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appliquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium; Department of Medicine, University of Montreal, Montreal Heart Institute, Montreal, Canada.
Departments of Cardiology and Radiology, University of Liège, Groupe Interdisciplinaire de Génoprotéomique Appliquée Cardiovascular Sciences, Heart Valve Clinic, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
Am J Cardiol. 2014 Aug 1;114(3):441-8. doi: 10.1016/j.amjcard.2014.04.053. Epub 2014 May 20.
B-type natriuretic peptide (BNP) level may be a useful prognostic marker for the management of asymptomatic patients with aortic stenosis (AS). The aim of this study was to identify the echocardiographic determinants of BNP changes during follow-up in AS. We studied 61 asymptomatic patients with greater than moderate AS and preserved left ventricular (LV) ejection fraction who underwent rest and exercise Doppler echocardiography with concomitant BNP level measurement at baseline. BNP measurement was repeated after inclusion every 6 months. Patients were divided into 2 groups according to the median of BNP changes during follow-up. According to parameters at rest, patients in the high BNP changes group had significantly higher E/e' ratio. Statistically significant correlations were found between BNP changes and E/e' ratio and indexed left atrial area. According to exercise parameters, patients in the high BNP changes group had significantly lower exercise-induced increase in LV ejection fraction. Statistically significant correlations were found between BNP changes and exercise-induced changes in LV ejection fraction. After adjustment for age, mean aortic pressure gradient, and BNP level at baseline, multivariate analysis identified indexed left atrial area, E/e' at rest, and exercise-induced increase in ejection fraction as independent determinants of BNP changes during follow-up. In conclusion, this study shows that, in asymptomatic patients with preserved LV function and moderate AS, serial BNP measurements may widely vary. Subclinical LV diastolic and systolic dysfunctions are frequently present in patients with higher serial BNP changes.
B 型利钠肽（BNP）水平可能是主动脉瓣狭窄（AS）无症状患者管理的有用预后标志物。本研究旨在确定 AS 患者随访期间 BNP 变化的超声心动图决定因素。我们研究了 61 名无症状、中重度 AS 且左心室（LV）射血分数正常的患者，他们在基线时接受了静息和运动多普勒超声心动图检查，并同时测量了 BNP 水平。在纳入后每 6 个月重复测量 BNP。根据随访期间 BNP 变化的中位数，患者分为两组。在静息状态下，BNP 变化较大组的 E/e' 比值显著较高。BNP 变化与 E/e' 比值和左心房指数之间存在显著相关性。根据运动参数，BNP 变化较大组的 LV 射血分数在运动时的增加显著降低。BNP 变化与 LV 射血分数在运动时的变化之间存在显著相关性。在校正年龄、平均主动脉压力梯度和基线 BNP 水平后，多变量分析确定左心房指数、静息时 E/e' 和射血分数在运动时的增加是随访期间 BNP 变化的独立决定因素。总之，本研究表明，在左心室功能正常且中度 AS 的无症状患者中，连续 BNP 测量可能差异很大。在 BNP 连续变化较大的患者中，常存在亚临床左心室舒张和收缩功能障碍。
