Key result
Elevated NT-proBNP is linked to ~12-fold higher odds of pulmonary hypertension in severe aortic stenosis.
Why the study?
Do biomarkers and left ventricular diastolic dysfunction parameters predict pulmonary hypertension in patients with severe aortic stenosis?
Observational (n=60)
No
Do biomarkers and left ventricular diastolic dysfunction parameters predict pulmonary hypertension in patients with severe aortic stenosis?
Odds Ratio: 12.54 (95% CI 2.8–55.99)
p-value: p=<0.001
In patients with severe aortic stenosis, left ventricular diastolic dysfunction and elevated NT-proBNP and GDF-15 levels are strong predictors of secondary pulmonary hypertension.
May flag secondary PH risk in severe AS; hypothesis-generating and requires prospective validation before guiding management.
Background: Severe aortic stenosis (AS) complicated by pulmonary hypertension (PH) is associated with poor outcomes after surgical aortic valve replacement (AVR). There is still scarce information about predictors of secondary PH in this group of patients. Objectives: The aim of this study was to investigate the prognostic impact of biomarkers together with conventional Doppler echocardiographic parameters of left ventricular diastolic function on elevated pulmonary systolic pressure (PSP) in severe AS patients before surgical AVR. Methods: Sixty patients with severe isolated AS (aortic valve area <1 cm2) underwent echocardiography, N-terminal pro B-type natriuretic peptide (NT-proBNP) and growth differentiation factor-15 (GDF-15) measurements before AVR. PSP, left ventricular ejection fraction (LV EF), parameters of LV diastolic function (E/E’ ratio, mitral valve deceleration time (MV DT) and left atrial (LA) volume) were evaluated. PH was defined as an estimated PSP ≥ 45 mmHg. Results: Of the 60 patients, 21.7% with severe isolated AS had PH with PSP ≥ 45 mmHg (58.5 ± 11.2 mmHg). LV EF did not differ between groups and was not related to an elevated PSP (50 ± 8 vs. 49 ± 8%, p = 0.58). Parameters of LV diastolic dysfunction (E/E’ ratio > 14 (OR 6.00; 95% CI, 1.41–25.48; p = 0.009), MV DT ≤ 177.5 ms (OR 9.31; 95% CI, 2.06–41.14; p = 0.001), LA volume > 100 mL (OR 9.70; 95% CI, 1.92–49.03; p = 0.002)) and biomarkers (NT-proBNP > 4060 ng/L (OR 12.54; 95% CI, 2.80–55.99; p < 0.001) and GDF-15 > 3393 pg/mL (OR 18.33; 95% CI, 2.39–140.39; p = 0.001)) were significantly associated with elevated PSP in severe AS. Conclusions: Left ventricular diastolic dysfunction and elevated biomarkers levels could predict the development of pulmonary hypertension in patients with severe aortic stenosis. Elevation of biomarkers paired with worsening of LV diastolic dysfunction could help to stratify patients for earlier surgical treatment before the development of pulmonary hypertension.
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Gumauskienė et al. (2018) conducted an observational in Severe aortic stenosis (n=60). Elevated NT-proBNP (> 4060 ng/L) vs. NT-proBNP ≤ 4060 ng/L was evaluated on Pulmonary hypertension (estimated pulmonary systolic pressure ≥ 45 mmHg) (OR 12.54, 95% CI 2.80-55.99, p=<0.001). Elevated NT-proBNP (>4060 ng/L) was significantly associated with the presence of pulmonary hypertension in patients with severe aortic stenosis (OR 12.54).
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