Utility of Exercise-induced N-terminal (NT) Pro-brain Natriuretic Peptide Levels in Predicting Prognosis in Asymptomatic Aortic Stenosis

Utility of Exercise-induced NT-pro-brain Natriuretic Peptide Levels in Predicting Prognosis in Asymptomatic Aortic Stenosis

One hundred patients with moderate to severe asymptomatic aortic stenosis (AS) will be asked to exercise on a treadmill. NT-pro-BNP levels will be drawn before and after exercise. Changes in NT-pro-BNP levels will be correlated to outcomes at one year. In the pilot phase an additional 10 control subjects without AS will be enrolled to document the control response of NT-pro-BNP elevations with exercise.

Inclusion Criteria:

1. valvular AS (Doppler velocity ≥ 3.0 m/s)
2. no baseline symptoms referable to valvular heart disease
3. able to perform ETT

Exclusion Criteria:

1. more than mild aortic regurgitation, mitral regurgitation/ stenosis, or tricuspid regurgitation/stenosis
2. previous AVR
3. known coronary artery disease
4. creatinine clearance 50 mL/min
5. LVEF < 50%
6. planned valve surgery prior to enrollment
7. significant pulmonary disease
8. unable to give informed consent
9. pregnancy