P247Global longitudinal strain in aortic stenosis according to NT-proBNP levels: identification of falsely asymptomatic patients.

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Purpose: Early impairment of LV function using Brain Natriuretic Peptide (BNP) level has been proposed to stratify asymptomatic Aortic Stenosis (AS) with a poor outcome. Recent studies suggest that longitudinal global strain by speckle tracking may be useful to detect early stages of LV dysfunction. The purpose of the present study is to establish the relationship between longitudinal global strain and NT-proBNP value in the setting of asymptomatic AS.Methods: The study included 128 patients (74+/−12years; 59% men,) with moderate to severe AS (1.0±0.3 cm2) with preserved LVEF(>50%, 64+/-5%). Longitudinal global strain by 2D speckle tracking was compared to the presence of symptoms and plasmatic NT-proBNP measurement.Results: On the whole, NT-proBNP averaged 723±1097 pg/mL and was higher in symptomatic patients (1203±1350 vs. 325±484 pg/mL, p<0.0001).However, elevated NT-proBNP level (>500pg/mL) was observed in 18% asymptomatic patients (n=14/79). In asymptomatic patients, no difference was found for LVEF (65±5 vs. 63±4%), peak aortic jet velocity (3.5±0.8 vs. 3.9±0.9m.s-1) or aortic valve area (1.1±0.4 vs. 1.0±0.4cm2) between patients with and without elevated NTproBNP. Importantly, global longitudinal strain was significantly impaired in asymptomatic patients with elevated NT-proBNP (−17±4% vs. –19±3%, p<0.05) and did not differ from symptomatic patients (−17±3%).Conclusion: Impaired longitudinal global strain in asymptomatic aortic stenosis is associated with an increase in NTproBNP level and may be used to better identify falsely asymptomatic patients.

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