Open AccessThe effect of aortic valve replacement on N‐terminal natriuretic propeptides in patients with aortic stenosis
Author(s) -
Qi Wei,
Mathisen Per,
Kjekshus John,
Simonsen Svein,
Endresen Knut,
Bjørnerheim Reidar,
Hall Christian
Publication year - 2002
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960250408
Subject(s) - medicine , cardiology , natriuretic peptide , left ventricular hypertrophy , stenosis , aortic valve replacement , atrial natriuretic peptide , aortic valve stenosis , hemodynamics , muscle hypertrophy , intracardiac injection , pulmonary wedge pressure , ventricular pressure , ventricular hypertrophy , aortic valve , blood pressure , heart failure
Background: Increased plasma concentrations of natriuretic peptides have been demonstrated to be associated with increased intracardiac pressure and left ventricular (LV) hypertrophy. After aortic valve replacement (AVR) in aortic stenosis patients, there is a relief of the left outflow obstruction with a substantial hemodynamic improvement. This is followed by a gradual regression of the LV hypertrophy. Hypothesis: After AVR, reduction in LV filling pressure is expected to occur rapidly, while regression of LV hypertrophy will take place over a longer time period. On this basis we hypothesized that the plasma levels of N‐terminal proatrial natriuretic peptide (NT‐proANP) would be reduced early in the postoperative period, while N‐terminal probrain natriuretic peptide (NT‐proBNP), through its closer reflection of LV hypertrophy, would be sustained for a longer period. Methods: Two groups of patients with aortic stenosis undergoing AVR were followed for 4 and 12 months, respectively. Plasma concentrations of NT‐pro ANP and NT‐proBNP were measured before and after AVR and related to preoperative findings and changes in the aortic valve area index. Results: Before AVR, the patients had significantly increased plasma levels of NT‐pro ANP and NT‐proBNP. After AVR, NT‐ pro ANP was decreased at 4 and 12 months but remained elevated compared with controls. N‐terminal‐proBNP tended to decrease, but did not change significantly. When the patients were followed for 12 months, only those with elevated preoperative pulmonary capillary wedge pressure had decreased peptide levels (NT‐proANP: p = 0.017, NT‐proBNP: p = 0.058). There was no regression of LV hypertrophy. The patients with the largest postoperative valve area index [1.27 (1.10‐1.55) cm 2 /m 2 ] had the largest reduction of NT‐proBNP (47%). Those with the smallest valve area index [0.67 (0.54‐0.73) cm 2 /m 2 ] had no decrease in NT‐proBNP. Conclusions: Our study suggests that a reduction in left atrial pressure is the main factor causing the change of NT‐proANP level after AVR. A small prosthetic valve orifice area with a high aortic valve gradient might prevent regression of LV hypertrophy, thus representing a stimulus for increased cardiac secretion of NT‐proBNP.