Background .– Several studies suggest that BNP testing may help define the timing of aortic valve surgery in patients with aortic valve stenosis (AVS) prior onset of overt LV systolic dysfunction. The aim of this study was to identify predictors of plasma BNP levels in a large cohort of patients with AVS and preserved LV ejection fraction.

Method and results .– One hundred and thirty-five consecutive patients were prospectively included in the present study (mean age 73 ± 13-year-old, 66 [49%] male, 89 [66%]) with severe aortic valve stenosis [aortic valve area < 0.6 cm ² /m ² BSA]). Plasma BNP levels, clinical and comprehensive Doppler echocardiography evaluation was performed in all patients. Independent clinical predictors of plasma BNP levels (R2 = 0.19) were older age ( P < 0.0001) and presence of AVS symptoms ( P = 0.004). Independent echocardiographic predictors of plasma BNP levels (R2 = 0.38) were E/e’ ratio ( P = 0.01), LV mass index ( P = 0.018), left atrial surface ( P < 0.0001) and systolic pulmonary artery pressure (sPAP) ( P = 0.004). Overall, independent predictors of plasma BNP levels (R2 = 0.47) were older age ( P = 0.001), known coronary artery disease ( P = 0.047), increased LV mass index ( P = 0.001), left atrial enlargement ( P = 0.002), and increased sPAP ( P = 0.003).

Conclusions .– In patients with AVS and normal LV ejection fraction, plasma BNP predominantly reflects the clinical and echocardiographic consequences of afterload burden imposed on the left ventricle rather than the severity of valve stenosis, per se. This may account for the strong prognostic value of BNP beyond indices of valvular stenosis severity in patients with AVS.