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Aortic Stenosis with Low Gradient and Normal Ejection Fraction: Clinical Value of Natriuretic Peptides
Rodolfo Pizarro, Pablo F. Oberti, Mariano L. Falconi, Anibal M. Arias, Juan G. Krauss, Arturo M. Cagide, Cesar A. Belziti.
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Background: The clinical significance of aortic stenosis (AS) with a low gradient, valve area <1 cm2 and normal ejection fraction (EF) remains controverted. The relevance of natriuretic peptides (NP) in this disorder has not been assessed until present. Objective: To assess the clinical significance of NP in patients (pts) with AS and low gradient, decreased valve area and normal EF. Methods A total of 106 pts with AS were prospectively included (mean age 74±11 y, 57% male, history of hypertension in 67%) , aortic valve area <1 cm2, mean gradient 55%). The value of NT-pro BNP associated to clinical and echocardiographic variables was assessed. Study end points were cardiac death and/or progression of dyspnea. Mean follow up was 2. 6 ± 1.3 years. Results Of the 106 pts, 6 p died due to cardiac causes (5.6%) and 39 p (36%) suffered progression of dyspnea. Mean NT-pro BNP value was 1295 ± 458. Patients with events had higher mean NT-pro BNP values than pts without events (1977±645 vs. 876±401, p 1100 pg/ml; sensitivity and specificity values of the ROC curve for end point detection were 81 % and 87%, respectively. Adjusting for clinical and echocardiographic variables, NT-pro BNP >1100 pg/ml (RR: 4.15 , 95% CI: 2.32-25.4, p75 years had better event discrimination ability (ROC area 0.89 vs. 0.79, p <0.0001). Conclusion: In pts with AS, a mean gradient <40 mmHg, aortic valve area <1 cm2 and normal EF, NP's could differentiate a population at greater risk, independently from the degree of valve calcification and LV mass.

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