Key result
An NT-proBNP cut-off of 334.00 pg/ml identified impaired coronary flow reserve (CFR ≤2.5) in asymptomatic moderate or severe aortic stenosis with an AUC of 0.67 (95% CI 0.54-0.79; p<0.01).
Why the study?
Does NT-proBNP measurement identify impaired coronary flow reserve in asymptomatic patients with moderate or severe aortic stenosis?
Observational (n=74)
Does NT-proBNP measurement identify impaired coronary flow reserve in asymptomatic patients with moderate or severe aortic stenosis?
Effect estimate: AUC 0.67 (95% CI 0.54-0.79)
p-value: p=< 0.01
Elevated NT-proBNP can serve as a non-invasive marker to identify impaired coronary flow reserve in asymptomatic patients with moderate or severe aortic stenosis and nonobstructive coronary arteries.
NT-proBNP may identify impaired CFR in asymptomatic aortic stenosis; hypothesis-generating and requires prospective validation before clinical use.
AIM: NT-proBNP has been shown to be a reliable biochemical marker for left ventricular wall stress. The relationship between NT-proBNP and coronary flow reserve (CFR) was evaluated in patients with significant asymptomatic aortic stenosis (AS). METHODS: A total of 74 patients with moderate or severe AS, mean age 66.68 ± 10.02 years (56.75% males), were enrolled in this prospective study. All patients underwent coronary angiography and had no obstructive coronary disease (defined as having no stenosis >50% in diameter). They had all undergone standard transthoracic Doppler-echo study and adenosine stress transthoracic-echo for CFR measurement and laboratory analysis for NT-proBNP measurement. RESULTS: The median NT-proBNP value was significantly increased (417.0 pg/ml; interquartile range [IQR]: 176.8-962.2 pg/ml). NT-proBNP was significantly higher in the group with CFR ≤2.5 (median: 549.0 pg/ml; IQR: 311.5-1131.0 pg/ml; as opposed to median: 291.5 pg/ml; IQR: 123.0-636.2 pg/ml; W = 452; p = 0.012). NT-proBNP showed significant negative correlation with CFR (ρ = -0.377, p = 0.001). There was also significant correlation between NT-proBNP and E/E´, S´ and aortic valve resistance. The NT-proBNP value of 334.00 pg/ml was determined as the best cut-off value for the diagnosis of CFR ≤2.5 (area under the curve: 0.67; 95%CI: 0.54-0.79; p < 0.01) and the sensitivity and specificity were 74 and 64%, respectively. CONCLUSION: Elevated NT-proBNP can indicate patients with impaired CFR in asymptomatic moderate or severe AS patients with preserved ejection fraction and nonobstructive coronary arteries.
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Banović et al. (2013) conducted an observational in asymptomatic moderate or severe aortic stenosis (n=74). NT-proBNP was evaluated on Diagnosis of impaired coronary flow reserve (CFR ≤2.5) (AUC 0.67, 95% CI 0.54-0.79, p=< 0.01). An NT-proBNP cut-off of 334.00 pg/ml identified impaired coronary flow reserve (CFR ≤2.5) in asymptomatic moderate or severe aortic stenosis with an AUC of 0.67 (95% CI 0.54-0.79; p<0.01).
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