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Can ‘low-risk’ patients with aortic stenosis be stratified?

By Dr Jonathan Shurlock

Patients with aortic stenosis (AS) have received increasing attention with recent work raising concerns regarding the assumption of being low risk in the context of non-severe, asymptomatic AS. Hadziselimovic et al. sought to provide some further evidence for the risk stratification of these patients through the analysis of the use of NT-proBNP monitoring. The authors analysed patients enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) randomised clinical trial. The primary outcome measure was aortic valve events (composite of AVR, CV death, and heart failure). NT-proBNP levels were collected at baseline and then annually over a 3 year follow up period. Data were collected for 1,644 patients (mean (SD) age: 67.5 (9.7) years).

1.5-fold or greater NT-proBNP level change from baseline was associated with the highest aortic valve event rates in both patients with both mild and moderate AS. The authors suggest the potential usefulness of the identified positive association between normal NT-proBNP concentrations and low aortic valve events and the importance of recognising the relationship between such events and an increased NT-proBNP level.

While much focus is on patients with severe or symptomatic aortic stenosis, the discussed data is essential for further understanding of appropriate monitoring assessment of those deemed ‘low-risk’.


  1. Hadziselimovic E, Greve AM, Sajadieh A, et al. Association of Annual N-Terminal Pro-Brain Natriuretic Peptide Measurements With Clinical Events in Patients With Asymptomatic Nonsevere Aortic Stenosis: A Post Hoc Substudy of the SEAS Trial. JAMA Cardiol. Published online February 16, 2022. doi:10.1001/jamacardio.2021.5916