Using Brain Natriuretic Peptide (bnp) As An Additional Metric For Determining Operative Candidates Amongst Veterans With Aortic Stenosis.
Matthew Skancke1, Jacob Lambdin1, Kendal Endicott1, Michael Greenberg2, Christian Nagy2, Richard Amdur2, Gregory Trachiotis1.
1George Washington University Hospital, Washington, DC, USA, 2Washington DC Veterans Affairs Medical Center, Washington, DC, USA.
OBJECTIVE: As the veteran population ages, the incidence of clinically significant aortic stenosis (AS) is becoming a health issue. Previous work, has shown that brain natriuretic peptide (BNP) has a positive correlation to mortality in veterans undergoing coronary revascularization at a Veteran's Affairs Medical Center (VAMC). This analysis focused on BNP as an adjunct to aid decision making for early aortic valve replacement (AVR) in veterans with AS and reduce hospital admission rates.
METHODS: We retrospectively reviewed patients referred to the heart valve clinic a single VAMC between 2006 and 2015 diagnosed with AS and identified 75 male veterans who had a BNP drawn in addition to traditional echocardiography during their diagnostic workup. This cohort was then subdivided into those who underwent surgery (n=41) versus those who were managed medically (n=34) and stratified based on their BNP values: 0-100, 101-300, 301-1000 and greater than 1000. The primary outcome of interest was admission to a VAMC for heart failure.
RESULTS: The mean age was 76 years in the medical and 71 years in the surgical group; the mean BMI was 29.2 and 32.3 (kg/m2) respectively. Univariate analysis of BNP stratification and operative status showed a reduction in number of admissions for those who underwent AVR (p=0.05). Post-hoc analysis clarified the reduction in average number of admissions for surgical patients vs. those treated medically with BNPs between 101-300 (0.636 vs. 3.714; p=0.042) and 300-1000 (1.364 vs. 4.00; p=0.006); BNP values between 0-100 and BNP values greater than 1000 showed no significant difference in average number of admissions. Post hoc testing further indicated that echocardiography values were similar between BNP stratifications except for ejection fraction in those with BNP values between 101-300 and BNP values greater than 1000 (p=0.032).
CONCLUSIONS: BNP may be a useful adjunct for selecting patients with AS for earlier AVR or in select cohorts after AVR leading to lower rates of hospital admissions in the veteran population. Continued analysis in a larger cohort will be beneficial to further validate the utility of BNP stratification as a diagnostic tool to risk stratify patients with asymptomatic AS in a valve clinic.
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