Prognostic impact of natriuretic peptide value in patients with symptomatic and asymptomatic severe aortic stenosis

Abstract 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.