Author + information
- Received February 27, 2017
- Revision received June 9, 2017
- Accepted June 21, 2017
- Published online July 2, 2018.
- Abdellaziz Dahou, MD, MSc,
- Marie-Annick Clavel, DVM, PhD,
- Romain Capoulade, PhD,
- Kim O’Connor, MD,
- Henrique B. Ribeiro, MD, PhD,
- Nancy Côté, PhD,
- Florent Le Ven, MD,
- Josep Rodés-Cabau, MD,
- Jean G. Dumesnil, MD,
- Patrick Mathieu, MD, MSc and
- Philippe Pibarot, DVM, PhD∗ ()
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Québec, Canada
- ↵∗Address for correspondence:
Dr. Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec, Québec G1V 4G5, Canada.
Objectives The objective of this study was to determine the prognostic value of combined measures of B-type natriuretic peptide (BNP) and high-sensitivity cardiac troponin T (hsTnT) in patients with low-flow, low-gradient aortic stenosis (LF-LG AS) who had either a preserved or reduced left ventricular ejection fraction (LVEF).
Background An elevated BNP level is associated with increased risk of mortality in patients with LF-LG AS. The incremental prognostic value of hsTnT in these patients is unknown.
Methods Ninety-eight patients (74 ± 10 years; 75% men) with LF-LG AS (LVEF <50% and/or stroke volume index <35 ml/m2, mean gradient <40 mm Hg, indexed aortic valve area <0.6 cm2/m2) who were prospectively enrolled in the TOPAS (Truly or Pseudo-Severe Aortic Stenosis) study were included. The cohort was divided into 3 groups according to BNP and hsTnT levels: group A: BNP <550 pg/ml and hsTnT <15 ng/l; group B: BNP ≥550 pg/ml or hsTnT ≥15 ng/l; and group C: BNP ≥550 pg/ml and hsTnT ≥15 ng/l. The primary endpoint was all-cause mortality.
Results Twenty-seven patients (27%) were in group A, 39 (40%) were in group B, and 32 (33%) were in group C. During a median follow-up of 2.8 years, 43 patients died. Two-year mortality was higher in group C (41 ± 9%) than in group B (23 ± 7%) and group A (5 ± 4%) (p = 0.002). In group B, there was no significant difference in 2-year mortality rates between the subgroup with hsTnT ≥15 ng/l (n = 29) and the subgroup with BNP ≥550 pg/ml (n = 10) (26 ± 9% vs. 11 ± 10%, respectively; p = 0.21). In multivariable analysis adjusted for age, type of treatment (aortic valve replacement vs. conservative therapy), coronary artery disease, and LVEF, being in group C remained independently associated with an increased risk of mortality (hazard ratio [HR]: 4.25; p = 0.023), and group B tended to have higher mortality (HR: 3.63; p = 0.058) compared with group A.
Conclusions This study demonstrated the usefulness of combined measures of BNP and hsTnT to enhance risk stratification in patients with LF-LG AS. Patients with elevation of both BNP and hsTnT had a markedly increased risk of mortality. (Multicenter Prospective Study of Low-Flow Low-Gradient Aortic Stenosis [TOPAS]; NCT01835028)
This work was supported by grants (MOP-57445, MOP-126072, FDN-143225) from the Canadian Institutes of Health Research, Ottawa, Canada. Dr. Dahou was supported by a fellowship grant from L’Agence de la santé et des services sociaux de la Capitale Nationale, Québec, Québec, Canada. Dr. Capoulade was supported by a postdoctoral fellowship from the Canadian Institutes of Health Research.
Dr. Pibarot holds the Canada Research Chair in Valvular Heart Diseases; and has received research grants from Edwards Lifesciences and Medtronic for echocardiography core laboratory analyses. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 27, 2017.
- Revision received June 9, 2017.
- Accepted June 21, 2017.
- 2018 American College of Cardiology Foundation