Key result
In patients with moderate to severe aortic regurgitation, increased plasma BNP was significantly associated with greater LV end-systolic volume index (r=0.33, p=0.04) on exercise echocardiography.
Why the study?
Does plasma BNP predict LV dysfunction on exercise echocardiography in patients with chronic moderate to severe aortic regurgitation?
Case-Control (n=49)
Does plasma BNP predict LV dysfunction on exercise echocardiography in patients with chronic moderate to severe aortic regurgitation?
Effect estimate: r = 0.33
p-value: p=0.04
In patients with moderate to severe aortic regurgitation, elevated BNP is associated with early left ventricular dysfunction on exercise echocardiography, although compensatory remodeling can occur without BNP elevation.
May flag early LV impairment on exercise in AR; hypothesis-generating and should not yet change practice.
Objective: To determine whether plasma levels of B-type natriuretic peptide (BNP) predict left ventricular (LV) dysfunction on exercise echocardiography in patients with moderate to severe aortic regurgitation (AR). Design: Case–control study. Setting: Outpatient cardiology departments. Patients: 39 asymptomatic or mildly symptomatic patients with chronic moderate to severe AR and a normal LV ejection fraction (>50%), and 10 normal controls. Main outcome measures: Plasma level of BNP and echocardiographic measures of LV function at rest and immediately after treadmill exercise. Results: LV end systolic volume index (LVESVI) was significantly increased in AR patients with normal BNP (⩽12 pmol/l) compared with controls (mean (SD) 32 (13) vs 17 (7) ml/m2, p = 0.002) but was similar for AR patients with normal and elevated BNP (38 (16), p = 0.14). In AR patients there was no association between plasma BNP and measures of LV function on echocardiography at rest (r<0.30, p>0.05 for all). However, there were modest but statistically significant associations between the plasma level of BNP and severity of AR indicated by a greater AR:LV outflow tract width ratio (r = 0.37, p = 0.02) and lower diastolic blood pressure (r = −0.44, p = 0.004). Increased BNP was also associated with a greater LVESVI (r = 0.33, p = 0.04) and lower LV longitudinal strain rate (r = −0.037, 0.02) on echocardiography after exercise. Conclusions: In moderate to severe AR compensatory LV remodelling can occur with no increase in plasma BNP. Increased BNP is associated with more severe regurgitation and changes consistent with early LV dysfunction on exercise echocardiography.
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Gabriel et al. (2007) conducted a case-control in Chronic moderate to severe aortic regurgitation (n=49). Plasma level of B-type natriuretic peptide (BNP) vs. Normal BNP (⩽12 pmol/l) or normal controls was evaluated on Left ventricular end systolic volume index (LVESVI) on echocardiography after exercise (r = 0.33, p=0.04). In patients with moderate to severe aortic regurgitation, increased plasma BNP was significantly associated with greater LV end-systolic volume index (r=0.33, p=0.04) on exercise echocardiography.