Brain Natriuretic Peptide as an Additional Metric for Determining Operative Candidates among Veterans with Aortic Stenosis

Objective: As the veteran population ages, the incidence of clinically significant aortic stenosis (AS) is increasing and aortic stenosis has become a veterans’ health issue. This analysis focused on using serum Brain Natriuretic Peptide (BNP) levels as an adjunct to aid decision making for early aortic valve replacement (AVR) in veterans with severe AS to reduce hospital admission rates. Methods: We retrospectively reviewed the charts of patients referred to the heart valve clinic at the Washington DC, Veterans Affairs Medical Center (VAMC) Heart Center between 2004 and 2015 who were diagnosed with severe AS. We identified veterans who had a BNP drawn in addition to traditional echocardiography during their diagnostic workup. This cohort was then stratified based on their serum BNP levels and whether they received medical therapy or aortic valve replacement. The primary endpoint of interest was admission to a VAMC for valvular heart failure. Results: Univariate analysis of BNP quartile and operative status showed a reduction in number of admissions for veterans who underwent AVR with BNP between 101 and 300 (0.64 vs. 3.71, p = 0.054) and 301 and 1000 (1.36 vs. 4.0, p = 0.003) compared to veterans treated medically. There was no difference in number of admissions for veterans with BNP lower than 100 (p = 0.455) or higher than 1000 (p = 0.659). Conclusion: BNP may be a useful adjunct for selecting patients with AS for earlier AVR leading to lower rates of hospital admissions in the veteran population. Continued analysis in a larger cohort will be needed to further validate the utility of BNP stratification as a diagnostic tool to risk stratify patients with AS in a heart valve clinic.