Natriuretic peptides in patients with aortic stenosis

Background Whereas atrial natriuretic peptide (ANP) is secreted mainly from cardiac atria, brain natriuretic peptide (BNP) is produced to a larger ext ent in ventricles. Their relative importance as markers of cardiac function and myocardial hypertrophy is not yet clarified. This study evaluated circ ulating BNP and ANP and the N-terminal part of their propeptides (NT-proBNP and NT-proANP) as markers of left ventricular hypertrophy and atrial press ure increase in patients with aortic stenosis. Methods The plasma concentrations of BNP, NT-proBNP, ANP, and NT-proANP wer e measured by radioimmunoassay in 67 patients with aortic stenosis. Peptide plasma concentrations were related to measurements obtained by cardiac cat heterization and echocardiography. Results Receiver operating characteristic curves indicated that BNP and NT- proBNP performed best in the detection of increased left ventricular mass a nd NT-proANP in the detection of increased left atrial pressure. NT-proBNP was significantly increased in mild left ventricular hypertrophy (left vent ricular mass index, 78 to 139 g/m(2)), whereas NT-proANP was not increased until left ventricular mass index was 141 to 180 g/m(2). Conclusions Plasma BNP and NT-proBNP may serve as early markers of left ven tricular hypertrophy, whereas ANP and NT-proANP reflect left atrial pressur e increase. The repeated and combined measurements of natriuretic peptides might provide diagnostic information relevant to the evaluation of the stag e of aortic stenosis.