Diagnosis and management of patients with asymptomatic severe aortic stenosis

Table 2 High-risk patients predicted from brain natriuretic peptide level

Source	BNP cut-off value	Results	Enrolled patients
Bergler-Klein et al[51]	BNP 130 pg/mL	BNP < 130 pg/mL (n = 25) had better symptom-free survival (P < 0.001)	Asymptomatic severe AS, EF ≥ 50% (n = 43)
Biner et al[33]	BNP 300 pg/mL	Combined use of BNP > 300 pg/mL and E/e’ > 15 predicted 1-yr mortality (hazard ratio = 2.59; 95%CI: 1.21-5.55, P = 0.014)	Severe AS, symptomatic and asymptomatic, any EF included (n = 79)
Berger-Klein et al[54]	BNP 550 pg/mL	BNP ≥ 550 pg/mL showed poorer survival both in medically and surgically treated groups	Indexed effective orifice area ≤ 0.6 cm2/m2 with low-flow/low-gradient AS; symptomatic and asymptomatic, with EF ≤ 40% (n = 69)
Clavel et al[52]	BNP ratio: Measured BNP/maximal-normal-BNP for age and sex	Higher BNP ratio showed worse mortality in asymptomatic patients with preserved EF (hazard ratio = 2.35; 95%CI: 1.57-3.56, P < 0.0001)	Total, moderate or severe AS, any EF (n = 1953) Asymptomatic, with EF > 50% (n = 565)

AS: Aortic stenosis; BNP: Brain natriuretic peptide; EF: Ejection fraction.