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Interest of biological markers in valvular heart disease Volume 3, issue 4, Juillet-Août 2007

Author
Service de cardiologie, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris

In valvular heart diseases, the development of left ventricular and left atrial alterations is insidious and associated with poor clinical outcome. A biomarker that reflects the development of early ventricular dysfunction would be of considerable interest. Since the production of natriuretic peptides is increased in response to cardiac overload, they may potentially fulfill this role. Comparisons of B type natriuretic peptide (BNP) and N-terminal peptide (NT-pro-BNP) concentrations, in patients and controls show that natriuretic peptides are activated in valvular heart disease. In organic mitral regurgitaion and aortic stenosis, BNP and NT-pro-BNP activations mainly reflect the consequences of the disease. Indeed, peptides concentrations are independently associated with symptoms and cardiac remodeling irrespective of the disease degree. Thus, BNP and NT-pro-BNP activations should direct the attention of clinicians toward severe hemodynamic, left ventricular and auricular alterations and may help to identify symptoms in difficult cases. Moreover, BNP concentrations appear to relate to prognosis. Indeed a high level of BNP independently predicts mortality and adverse cardiovascular events. These peptides may help to identify high risk patients who need to be carefully followed with reassessment for the need of surgery. Thus, natriuretic peptides emerge as promising tools in the evaluation of valvular diseases. Larger series, including mainly asymptomatic patients, are needed to routinely measure BNP in valvular diseases and to integrate it in the clinical decision-making process.