Key result
Highly elevated natriuretic peptides linked to up to ~70% greater death or HF risk in severe AS.
Why the study?
There is a scarcity of data on the prognostic value of natriuretic peptides in either symptomatic or asymptomatic patients with severe aortic stenosis.
Does elevated natriuretic peptide predict all-cause death or heart failure hospitalization in patients with severe aortic stenosis?
Cohort (n=2,825)
Yes
Does elevated natriuretic peptide predict all-cause death or heart failure hospitalization in patients with severe aortic stenosis?
Highly elevated natriuretic peptide levels independently predict a higher risk of all-cause death or heart failure hospitalization in both symptomatic and asymptomatic patients with severe aortic stenosis.
Answers are grounded in this paper and cite their sources.
Highly elevated natriuretic peptides signal higher risk in severe aortic stenosis regardless of symptoms; supports prognostic value but leaves open management implications.
Background There is a scarcity of data on the prognostic value of natriuretic peptide (NP) in either symptomatic or asymptomatic severe aortic stenosis (AS) patients. Purpose The purpose of this study is to investigate the prognostic impact of NP values at the diagnosis of severe AS patients stratified by symptomatic status. Methods We analyzed the 3369 of severe AS patients from CURRENT AS Registry-2, which was a prospective multicenter registry conducted in Japan between September 2018 and December 2020. After excluding 544 patients with missing NP value at the index echocardiography, we stratified the 2825 study patients according to the symptomatic status due to AS at baseline (Symptomatic: N=1863, and Asymptomatic: N=962). Each population was divided into 3 groups according to BNP or NT-proBNP value (G1: Low NP [BNP <100 pg/ml or NT-proBNP <300pg/ml], G2: Mildly elevated NP [BNP 100-199 pg/ml or NT-proBNP 300-899pg/ml], G3: Highly elevated NP [BNP >=200 pg/ml or NT-proBNP >=900 pg/ml]). The primary outcome measure of this study was a composite of all-cause death or heart failure (HF) hospitalisation. Results Among both symptomatic and asymptomatic patients, patients in the elevated NP groups (G2 and G3) were older and more often had history of myocardial infarction, HF hospitalisation, atrial fibrillation, chronic kidney disease and anemia than those in the low NP group (G1). The cumulative 2-year incidence of the primary outcome measure was significantly higher in the elevated NP groups than in the low NP group regardless of symptomatic status (Symptomatic: G1: 12%, G2: 23%, and G3:49%, log-rank P<0.01; Asymptomatic: G1: 10%, G2: 24% and G3: 45%, log-rank P<0.01). G3, but not G2 compared with G1 was associated with a higher adjusted risk of the primary outcome regardless of symptomatic status (Symptomatic:G2: HR 1.20, 95%CI 0.91-1.58, P=0.20 and G3: HR 1.56, 95%CI 1.22-1.98, P<0.01; Asymptomatic: G2: HR 1.33, 95%CI 0.92-1.92, P=0.13 and G3: HR 1.70, 95%CI 1.18-2.46, P<0.01). Conclusion Highly elevated NP was independently associated with poorer outcome in both symptomatic and asymptomatic patients with severe AS.
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Murai et al. (2025) conducted a cohort in severe aortic stenosis (n=2,825). Highly elevated natriuretic peptide (BNP >=200 pg/ml or NT-proBNP >=900 pg/ml) vs. Low natriuretic peptide (BNP <100 pg/ml or NT-proBNP <300pg/ml) was evaluated on composite of all-cause death or heart failure (HF) hospitalisation (HR 1.56 (symptomatic), HR 1.70 (asymptomatic), 95% CI 1.22-1.98 (symptomatic), 1.18-2.46 (asymptomatic), p=<0.01). Highly elevated natriuretic peptides increased the risk of death or heart failure hospitalization in symptomatic (HR 1.56) and asymptomatic (HR 1.70) severe aortic stenosis patients.
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