1. Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis
- Author
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Emilio Attena, Bernard Cosyns, Julien Magne, Kim O'Connor, Luc Pierard, Patrizio Lancellotti, Marie Moonen, Erwan Donal, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-Research), Université de Liège, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Service de cardiologie et maladies vasculaires, Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]
- Subjects
Male ,MESH: Echocardiography, Doppler ,030204 cardiovascular system & hematology ,MESH: Risk Assessment ,Doppler imaging ,MESH: Proportional Hazards Models ,Ventricular Dysfunction, Left ,MESH: Aged, 80 and over ,0302 clinical medicine ,[INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing ,Aortic valve replacement ,MESH: Risk Factors ,Risk Factors ,MESH: Ventricular Dysfunction, Left ,Natriuretic Peptide, Brain ,Natriuretic peptide ,MESH: Natriuretic Peptide, Brain ,Prospective Studies ,030212 general & internal medicine ,MESH: Aortic Valve Stenosis ,MESH: Aged ,Aged, 80 and over ,MESH: Middle Aged ,MESH: Follow-Up Studies ,Middle Aged ,Prognosis ,Echocardiography, Doppler ,3. Good health ,MESH: Reproducibility of Results ,MESH: Survival Analysis ,Circulatory system ,cardiovascular system ,Cardiology ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,[SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing ,Adult ,medicine.medical_specialty ,medicine.drug_class ,Risk Assessment ,Sensitivity and Specificity ,Asymptomatic ,MESH: Multivariate Analysis ,MESH: Prognosis ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Afterload ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Aged ,Proportional Hazards Models ,MESH: Humans ,business.industry ,MESH: Biological Markers ,Reproducibility of Results ,MESH: Adult ,Aortic Valve Stenosis ,medicine.disease ,Survival Analysis ,MESH: Prospective Studies ,MESH: Sensitivity and Specificity ,MESH: Male ,Annular velocity ,Stenosis ,Multivariate Analysis ,business ,MESH: Female ,Biomarkers ,Follow-Up Studies - Abstract
International audience; In aortic stenosis (AS), the increased afterload results in progressive structural and functional changes that precede the development of symptoms. We hypothesized that the detection of abnormalities in left ventricular long-axis function could identify patients with asymptomatic AS at increased risk of events. We prospectively examined the outcome of 126 patients with asymptomatic AS who underwent a comprehensive echocardiographic examination, including tissue Doppler imaging. B-type natriuretic peptide (BNP) was measured in all patients. During a median follow-up period of 20.3 + or - 17.8 months, 6 patients died, 8 developed symptoms but did not undergo surgery, and 48 underwent aortic valve replacement. On multivariate Cox regression analysis, the parameters associated with the predefined outcome were gender (p = 0.048), left atrial area index (p = 0.011), systolic annular velocity (p = 0.016), E/Ea ratio (p = 0.024), late diastolic annular velocity (p = 0.023), and BNP (p = 0.012). Using receiver operating characteristics curve analysis, a left atrial area index of > or = 12.4 cm(2)/m(2), systolic annular velocity of < or = 4.5 cm/s, E/Ea ratio >13.8, late diastolic annular velocity of < or = 9 cm/s, and BNP of > or = 61 pg/ml were identified as the best cutoff values to predict events. In conclusion, in asymptomatic AS, tissue Doppler imaging and BNP measurements provide prognostic information beyond that from clinical and conventional echocardiographic parameters.
- Published
- 2010
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