Journal Article

Transcardiac gradients of N-terminal B-type natriuretic peptide in aortic valve stenosis

Markku Kupari, Heikki Turto, Jyri Lommi, Markku Mäkijärvi and Hannu Parikka

in European Journal of Heart Failure

Published on behalf of European Society of Cardiology

Volume 7, issue 5, pages 809-814
Published in print August 2005 | ISSN: 1388-9842
Published online August 2005 | e-ISSN: 1879-0844 | DOI: https://dx.doi.org/10.1016/j.ejheart.2004.10.011
Transcardiac gradients of N-terminal B-type natriuretic peptide in aortic valve stenosis

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Background

Plasma B-type natriuretic peptide (BNP), as well as the N-terminal part of the prohormone (Nt-BNP), are frequently elevated in aortic valve stenosis (AS). Yet, their release from the heart into the circulation has never been directly studied in AS.

Aim

To assess the release of Nt-BNP in AS with focus on the identification of its main determinants.

Methods

We studied 49 adult patients undergoing preoperative cardiac catheterization for isolated AS. Blood was sampled from the aortic root and the coronary sinus for Nt-BNP determination by immunoassay.

Results

The mean (±S.E.) transcardiac Nt-BNP step-up averaged 79±53 pmol/l in 11 control patients free of structural heart disease, 75±32 pmol/l in 31 AS patients free of heart failure (HF), 236±62 pmol/l in 8 AS patients with diastolic HF (ejection fraction ≥50%, pulmonary wedge pressure >14 mm Hg) and 469±66 pmol/l in 7 AS patients with systolic HF (ejection fraction <50%, wedge pressure >14 mm Hg) (p<0.001). The transcardiac Nt-BNP gradient was independently associated with left ventricular (LV) end-diastolic pressure (β=0.47, p<0.001) and ejection fraction (β=−0.29, p<0.019) and with co-existent coronary artery disease (β=0.23, p=0.050).

Conclusion

LV diastolic and systolic dysfunction along with coronary artery disease are likely to be the key determinants of cardiac Nt-BNP release in AS. The transcardiac Nt-BNP gradient increases on average three-fold with the development of diastolic HF and six-fold in systolic HF.

Keywords: Natriuretic peptides; Aortic valve stenosis; Heart failure

Journal Article.  3235 words.  Illustrated.

Subjects: Cardiovascular Medicine

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