Background:

The aortic valve replacement (AVR) indication in asymptomatic patients with severe aortic stenosis (AS) and preserved function is being increasingly discussed.

Objective:

The aim of this study was to evaluate whether the elevation of N-terminal fraction of the pro-B-type natriuretic peptide (NT-proBNP) predicts the occurrence of symptoms and the AVR indication in patients with severe AS and preserved left ventricular ejection fraction (LVEF), initially asymptomatic.

Methods:

Asymptomatic patients with severe AS, preserved LVEF (≥55%) and no initial AVR indication were prospectively included. All patients underwent laboratory tests measuring NT-proBNP at baseline, and an echocardiogram with tissue Doppler recording the lateral wall S wave (lat. S) and the E/e´ ratio. The endpoint was the aortic valve replacement indication at follow-up.

Results:

We included 133 patients aged 69 ± 8 years, 49% of which were women. After a follow-up of 570 (interquartile range 380-680) days, 23.3% (n=31) of them required aortic valve replacement. In the multivariate analysis, NT-proBNP value and the E/e' ratio were independent predictors of surgery (HR 1.02, 95% CI 1.001-1.03, p<0.001 and HR 1.42, 95% CI 1.21-2.45, p< 0.001, respectively). NT-proBNP presented an area under the curve (AUC) greater than the E/e’ ratio (0.88 versus 0.64, p=0.02). The best NT-proBNP cut-off point was determined as >350 pg./mL (adjusted HR 1.55, 95% CI 1.38-2.01, p<0.001).

Conclusion:

NT-proBNP value and the E/e' ratio were independent predictors of AVR requirement. NT-proBNP had a very good discrimination capacity, greater than the E/e´ ratio.