Author + information
- Received April 19, 2011
- Revision received June 30, 2011
- Accepted July 26, 2011
- Published online October 11, 2011.
- Rodolfo Pizarro, MD⁎ (, )
- Oscar O. Bazzino, MD,
- Pablo F. Oberti, MD,
- Mariano L. Falconi, MD,
- Aníbal M. Arias, MD,
- Juan G. Krauss, MD and
- Arturo M. Cagide, MD
- ↵⁎Reprint requests and correspondence:
Dr. Rodolfo Pizarro, Coronary Care Unit, Cardiology Division, Hospital Italiano de Buenos Aires, 4190 Juan D. Perón Street, 1181 Buenos Aires, Argentina
Objectives The purpose of this study was to determine the independent and additive prognostic value of B-type natriuretic peptide (BNP) in patients with severe asymptomatic aortic regurgitation and normal left ventricular function.
Background Early surgery could be advisable in selected patients with chronic severe aortic regurgitation, but there are no uniform criteria to identify candidates who could benefit from this strategy. Assessment of BNP has not been studied for this purpose.
Methods We prospectively evaluated 294 consecutive patients with severe asymptomatic organic aortic regurgitation and left ventricular ejection fraction above 55%. The first 160 consecutive patients served as the derivation cohort and the next 134 patients served as a validation cohort. The combined endpoint was the occurrence of symptoms of congestive heart failure, left ventricular dysfunction, or death at follow-up.
Results The endpoint was reached in 45 patients (28%) of the derivation set and in 35 patients (26%) of the validation cohort. Receiver-operator characteristic curve analysis yielded an optimal cutoff point of 130 pg/ml for BNP that was able to discriminate between patients at higher risk in both cohorts. BNP was the strongest independent predictor by multivariate analysis in the derivation set (odds ratio: 6.9 [95% confidence interval: 2.52 to 17.57], p < 0.0001) and the validation set (odds ratio: 6.7 [95% confidence interval: 2.9 to 16.9], p = 0.0001).
Conclusions Among patients with severe asymptomatic aortic regurgitation and normal left ventricular function, BNP ≥130 pg/ml categorizes a subgroup of patients at higher risk. Because of its incremental prognostic value, we believe BNP assessment should be used in the routine clinical evaluation of these patients.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 19, 2011.
- Revision received June 30, 2011.
- Accepted July 26, 2011.
- American College of Cardiology Foundation