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This editorial refers to ‘Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve disease’† by Weber et al. , on page 1023 Close to 3% of the population over the age of 65 suffers from significant aortic valve disease, a figure likely to rise in our aging population. The current guidelines reflect the ample evidence supporting surgical intervention in symptomatic patients.1 However, optimal treatment of asymptomatic patients with severe disease remains undetermined. The risk of surgical intervention outweighs the risk of sudden cardiac death in asymptomatic patients with severe aortic stenosis (AS), but determining whether a given patient is truly asymptomatic may be difficult. Patients may not recognize their symptoms because of the insidious nature of the disease or the patients' inactivity may preclude the development of symptoms. Exercise stress testing is gaining acceptance in the assessment of patients with severe AS, because it provides an objective assessment of functional and symptomatic status. However, it is performed in <6% of such patients, reflecting the established teaching that severe AS is a contraindication to the exercise stress test.2There is a need for a reliable method … *Corresponding author. Tel: +1613 761 4189; fax: +1613 761 4170. E-mail address : kchan{at}ottawaheart.ca

Should brain natriuretic peptides be measured in patients with aortic valve disease?