Prognostic value of plasma B-type natriuretic peptide levels after exercise in patients withsevere asymptomatic aortic stenosis.

The timing of surgery in patients with asymptomatic severe aortic stenosis (AS) remains a matter of debate. In this study, the authors evaluate the prognostic value of plasma levels of B-type natriuretic peptide (BNP) during exercise in 211 patients with asymptomatic AS.  In multivariate analysis, second and third tertiles of peak-exercise BNP were strong predictors of death or aortic valve replacement motivated by development of symptoms or LV dysfunction, compared with the first tertile. Patients with asymptomatic severe AS and a high peak BNP values may require closer follow up and may benefit from earlier surgery.