P420Prognostic value of natriuretic peptide and echocardiographic parameters in asymptomatic severe aortic stenosis

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Recently, valvuloarterial impedance(ZVa), E/é ratio and natriuretic peptide (NTproBNP) have been proposed as parameters with prognostic information in p with aortic stenosis (AS). Purpose: To determine the predictive value of NTproBNP and echocardiographic parameters as markers of death or need for aortic valve replacement in p with asymptomatic severe AS and preserved left ventricular ejection fraction (LVEF).Methods: We prospectively evaluated 85 p with severe AS(AVA≤ 1 cm2) and EF≥50%, excluding those with other significant valve disease. At the time of inclusion, clinical and echocardiographic assessment and a determination of NT-proBNP were performed. Patients were followed up for a median of 14 months (9-29) and were classified into two groups: 1.Asymptomatic p during follow-up. 2. Surgically treated p because of onset of symptoms or p who died. We compared clinical and echocardiographic parameters and NTproBNP levels between the two groups.Results: 36% were women. The differences between the baseline characteristics of the two groups are in Table 1. In the univariate analysis, ZVa was the only parameter of AS severity without prognostic value. In multivariate analysis, the peak velocity and the NTproBNP, were predictors of surgery/death and none of the other echocardiographic parameters showed prognostic value.Conclusions: In p with asymptomatic severe AS and preserved LVEF, the most powerful predictor of aortic valve replacement/death was the peak aortic velocity. NT-proBNP had an independent prognostic value, but showed great variability.

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