Review article
Natriuretic peptides in aortic stenosis
Peptídeos natriuréticos na estenose aórtica
Lido
10253
Vezesque se leu este artigo
2477
Total PDF
7776
Total HTML
Compartilhar estatísticas
array:24 [ "pii" => "S0870255112001746" "issn" => "08702551" "doi" => "10.1016/j.repc.2012.07.003" "estado" => "S300" "fechaPublicacion" => "2012-10-01" "aid" => "146" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Port Cardiol. 2012;31:655-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7102 "formatos" => array:3 [ "EPUB" => 195 "HTML" => 5662 "PDF" => 1245 ] ] "itemSiguiente" => array:20 [ "pii" => "S087025511200176X" "issn" => "08702551" "doi" => "10.1016/j.repc.2012.01.020" "estado" => "S300" "fechaPublicacion" => "2012-10-01" "aid" => "148" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2012;31:661-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 10463 "formatos" => array:3 [ "EPUB" => 191 "HTML" => 9028 "PDF" => 1244 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso Clínico</span>" "titulo" => "Coração carcinóide – a propósito de um caso clínico" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "661" "paginaFinal" => "665" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Carcinoid heart – Case report" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1491 "Ancho" => 1650 "Tamanyo" => 320508 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Envolvimento carcinóide da válvula tricúspide. A – Apical 4 câmaras, em sístole, que revela dilatação das cavidades direitas, com folhetos da válvula tricúspide espessados, que não coaptam, em posição semiaberta. B – Doppler-cor demonstrando insuficiência tricúspide grave. C – Pormenor em ecocardiografia tridimensional, com comparação das válvulas tricúspide e mitral, observado da face ventricular. C1 – Pormenor de ecocardiografia tridimensional, em diástole, mostrando folhetos da válvula tricúspide fixos, imóveis, espessados quando comparados com os folhetos da válvula mitral. C2 – Pormenor de ecocardiografia tridimensional, em sístole, revelando o encerramento da válvula mitral e o não encerramento da válvula tricúspide. D – Doppler contínuo que revela a insuficiência tricúspide. VT – Válvula tricúspide; VM – Válvula mitral.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Rita Santos, Bruno Stuart, Carlos Cotrim, Ana Rita Almeida, Paula Fazendas, Liliana Lopes, Inês Cruz, Hélder Pereira" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Ana Rita" "apellidos" => "Santos" ] 1 => array:2 [ "nombre" => "Bruno" "apellidos" => "Stuart" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Cotrim" ] 3 => array:2 [ "nombre" => "Ana Rita" "apellidos" => "Almeida" ] 4 => array:2 [ "nombre" => "Paula" "apellidos" => "Fazendas" ] 5 => array:2 [ "nombre" => "Liliana" "apellidos" => "Lopes" ] 6 => array:2 [ "nombre" => "Inês" "apellidos" => "Cruz" ] 7 => array:2 [ "nombre" => "Hélder" "apellidos" => "Pereira" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204912001377" "doi" => "10.1016/j.repce.2012.07.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204912001377?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511200176X?idApp=UINPBA00004E" "url" => "/08702551/0000003100000010/v1_201308021325/S087025511200176X/v1_201308021325/pt/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S0870255112001771" "issn" => "08702551" "doi" => "10.1016/j.repc.2012.07.005" "estado" => "S300" "fechaPublicacion" => "2012-10-01" "aid" => "149" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2012;31:647-54" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8409 "formatos" => array:3 [ "EPUB" => 205 "HTML" => 6649 "PDF" => 1555 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>" "titulo" => "Impacto da via verde coronária e da angioplastia primária na redução da mortalidade associada ao enfarte com elevação do segmento ST anterior. A experiência algarvia" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "647" "paginaFinal" => "654" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The impact of direct access to primary angioplasty on reducing the mortality associated with anterior ST-segment elevation myocardial infarction: The experience of the Algarve region of Portugal" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 765 "Ancho" => 2149 "Tamanyo" => 86168 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribuição mensal dos doentes com EAMCST anterior ao longo do ano de 2008.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nuno Marques, Ricardo Faria, Pedro Sousa, Jorge Mimoso, Victor Brandão, Veloso Gomes, Ilídio Jesus" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Nuno" "apellidos" => "Marques" ] 1 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Faria" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Sousa" ] 3 => array:2 [ "nombre" => "Jorge" "apellidos" => "Mimoso" ] 4 => array:2 [ "nombre" => "Victor" "apellidos" => "Brandão" ] 5 => array:2 [ "nombre" => "Veloso" "apellidos" => "Gomes" ] 6 => array:2 [ "nombre" => "Ilídio" "apellidos" => "Jesus" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204912001407" "doi" => "10.1016/j.repce.2012.08.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204912001407?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255112001771?idApp=UINPBA00004E" "url" => "/08702551/0000003100000010/v1_201308021325/S0870255112001771/v1_201308021325/pt/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Natriuretic peptides in aortic stenosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "655" "paginaFinal" => "660" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Paulo Torres-Ramalho, José Paulo Araújo, Paulo Bettencourt, Luís M. Moura" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Paulo" "apellidos" => "Torres-Ramalho" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 1 => array:3 [ "nombre" => "José Paulo" "apellidos" => "Araújo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Paulo" "apellidos" => "Bettencourt" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "Luís M." "apellidos" => "Moura" "email" => array:1 [ 0 => "luismoura@med.up.pt" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Medicina Interna, Hospital de São João, Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital Pedro Hispano, Matosinhos, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Faculdade de Medicina da Universidade do Porto, Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Peptídeos natriuréticos na estenose aórtica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Gerber et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1125 "Ancho" => 1573 "Tamanyo" => 72635 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Association between BNP levels and severity of aortic stenosis, showing BNP levels (median [upper quartile]) in normal controls and in subgroups of patients with aortic stenosis by aortic valve area, symptoms, and LV systolic function. AVA: aortic valve area; EF: ejection fraction.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aortic stenosis (AS) is the most common of all valvular heart diseases in the developed world and its prevalence may double in the next 20 years as populations age.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The management of AS usually involves monitoring for clinical symptoms and functional deterioration generally assessed by transthoracic echocardiography. The current treatment of choice in symptomatic AS is aortic valve replacement (AVR), but the optimal timing for surgery in asymptomatic patients remains controversial.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> A watchful waiting strategy is both safe and viable, but the risk of sudden death is not negligible, reaching almost 5% per year,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and the association between symptom status and AS severity may not always be linear.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Biomarkers are defined as biological molecules that can be identified in a particular disease and can additionally assess the severity and prognosis or monitor the response to treatment of that disease state.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In valvular disease, a strong biomarker will be very useful, potentially avoiding the need for costly imaging studies and providing support to clinical management decisions, particularly the optimal timing for intervention in asymptomatic AS. Natriuretic peptides (NPs) are endogenous cardiac hormones that have shown utility as biomarkers in heart failure,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> ischemic heart disease<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> and pulmonary hypertension.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> This review examines the role of NPs as potential biomarkers in the management of AS, with particular emphasis on asymptomatic severe AS.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Natriuretic peptides</span><p id="par0015" class="elsevierStylePara elsevierViewall">The NP system consists of three main peptides: atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and C-type natriuretic peptide (CNP). Their complex physiology will not be discussed here in detail as it has been extensively reviewed elsewhere.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> BNP and ANP exist as prohormones that are cleaved into inactive N-terminal fragments (N-terminal proBNP [NT-proBNP], N-terminal proANP [NT-proANP]) and biologically active hormones (BNP, ANP) before release into the circulation (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). The N-terminal fragments are more stable <span class="elsevierStyleItalic">in vivo</span> and are often used as surrogate markers for the biologically active hormone. The predominant cardiac source of ANP is the atria, while the ventricles are the main cardiac source of BNP, although both can be synthesized in either chamber. The stimulus for ANP and BNP release is primarily myocyte stretch, but endothelin-<span class="elsevierStyleSmallCaps">I</span>, nitric oxide, and angiotensin II may all have a role. ANP concentrations are more closely related to left atrial (LA) pressure and BNP to left ventricular (LV) pressure. CNP is structurally distinct from ANP and BNP; it is expressed to a much greater extent in the central nervous system and vascular tissues than in the heart, acting as a potent vasorelaxant and inhibitor of vascular smooth muscle proliferation and endothelial cell migration. Three natriuretic peptide receptors (NPRs) have been identified: NPR-A and NPR-B, which mediate their biological action, and NPR-C, which is a clearance receptor. NPs’ cardiovascular and renal actions include natriuresis, increase in glomerular filtration, systemic vasodilation, inhibition of renin release, reduction of left ventricular remodeling, and reduction of venous and wedge pressures. Additionally, NPs, their processing enzymes, and their receptors are expressed in the cardiac valves themselves.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Natriuretic peptides in aortic stenosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">On the basis of currently available evidence, the need for better risk stratification of asymptomatic patients with moderate to severe AS is widely accepted, and biomarkers may play an important role here. The ideal biomarker should be easily and reliably measured, reflect disease severity, increase with disease progression, and discriminate between patients in whom symptoms will or will not develop in the short to medium term. In comparison with controls, AS has been strongly associated with increased NP levels.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> In AS, pressure overload induces significant expression of BNP and NT-proBNP.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,19</span></a> ANP levels have also been demonstrated to be raised in proportion to LV end-systolic wall stress in patients with AS.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Severity of aortic stenosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Several studies have shown a correlation between plasma NP levels and severity of AS.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,21–24</span></a> This is the case for both BNP and NT-proBNP. Although there is a correlation between transvalvular gradients and NT-proBNP levels,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> more recent data suggest that the best correlation between NP levels and severity of AS is observed when aortic valve area is used as a categorical variable (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). <a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,25,26</span></a> Although a good overall correlation with aortic parameters of severity is observed, NPs should not be considered a replacement for an expert baseline echocardiographic evaluation of the patient, but as additional and important prognostic information.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Symptomatic status in aortic stenosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">NPs are higher in symptomatic than in asymptomatic patients with AS. NT-proBNP and BNP increases significantly with AS severity, onset of symptoms and LV dysfunction. In symptomatic patients, NPs increase with New York Heart Association (NYHA) functional class, irrespective of the severity of AS.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,21,23,27</span></a> BNP has good diagnostic accuracy in patients in NYHA functional class III to IV (area under the receiver-operator curve 0.78 [95% CI: 0.66 to 0.87; best cutoff 254.64 pg/ml]).<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Its ability to differentiate asymptomatic from minimally symptomatic (i.e., NYHA functional classes I and II) patients is weaker, with studies showing contradictory results.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,23</span></a> Angina and syncope do not seem to be related to natriuretic peptides,<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,25,27</span></a> possibly reflecting differences in the pathophysiology of these symptoms compared with dyspnea. Therefore, high NPs in a possibly asymptomatic patient or in a symptomatic patient with unclear symptoms appears to point to underlying progression of the disease, and these patients should be monitored closely.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Outcome in severe unoperated aortic stenosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">The timing for identifying symptom development in asymptomatic AS is crucial in the progression of the disease and has important prognostic impact. There is evidence that asymptomatic patients with severe AS and high NP levels developed symptoms earlier and significantly more often than patients with lower levels.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,28</span></a> Baseline plasma NP levels are higher in patients developing symptoms and needing surgery compared with asymptomatic patients during follow-up.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Aortic valve area, peak aortic velocity and LV ejection fraction were less reliable predictors of symptom onset.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Different NP cutoff levels have been proposed in diverse studies on AS regarding the optimal timing for surgery. However, single-value reference cutoffs as in heart failure<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> may not be appropriate; it might be preferable to assess individual baseline NPs levels and monitor for a possible increase during 3- to 6-month follow-up.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Elevated plasma NPs has been shown to predict survival in patients with severe AS. In Nessmith et al.’s study,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> in elderly patients with moderate to severe AS, survival was significantly influenced by the presence of symptoms (relative risk: 7.5, p<0.01) and BNP tertile (relative risk: 2.9, p<0.001). One-year mortality without surgery was 6%, 34%, and 60% with increasing tertiles. No patients with BNP <100 pg/ml died in the first year and the combination of BNP and symptoms provided a better prediction of survival than symptoms alone.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Patients with AS and death due to congestive heart failure or adverse events due to cardiac decompensation have consistently higher BNP levels.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,23,27,30</span></a> Less data are available for NPs and sudden death, especially in asymptomatic AS. The risk of sudden death, although it may be low overall, must be considered in patients with severe asymptomatic AS.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31,32</span></a> Low BNP may not be able to preclude the risk of sudden death in AS; it has been observed that AS patients with sudden death also had relatively low levels of BNP or NT-proBNP.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,25</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Postoperative outcome following aortic valve replacement</span><p id="par0045" class="elsevierStylePara elsevierViewall">Immediately after surgical AVR, NPs rise<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33,34</span></a> and then after 6 and 12 months post-AVR, decrease significantly, reflecting substantial hemodynamic improvement, but without returning to normal levels.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,35</span></a> These decreases occur in parallel with decreases in mean transvalvular pressure gradient and left ventricular mass.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Post-AVR changes in LA volume and LA pressure are reflected in ANP<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> and NT-proANP<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> levels, respectively. Persistently elevated BNP levels postoperatively appear to point to poor overall outcome late after aortic valve replacement. BNP may remain elevated in aortic prosthesis mismatch due to residual aortic gradient and increased LV myocardial wall pressure, leading to the poor outcomes observed in these patients. Weber et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> showed a significant decrease in NT-proBNP as a function of type and size of aortic prosthesis. Patients with bioprostheses had higher postoperative NT-proBNP levels compared to mechanical prostheses, although this was age-related. Smaller prosthesis size was associated with higher transvalvular gradients and a tendency toward higher NT-proBNP levels.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patients without symptomatic improvement tend to have nonsignificant decreases in NT-proBNP and LV mass even though the transvalvular pressure gradient decreases.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Several studies have evaluated the prognostic impact of NPs on survival in operated patients with severe AS. Pedrazzini et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> observed that BNP level was an independent predictor of perioperative and long-term mortality and was superior to the commonly used logistic EuroSCORE. Patients with logistic EuroSCORE greater than 10.1% had a higher risk of dying over time (hazard ratio [HR] 2.86; p=0.037), as had patients with BNP greater than 312 pg/ml (HR 9.01; p<0.001). However, only BNP was an independent predictor of death (HR 8.2; p=0.002). Importantly, BNP should not be considered as a stand-alone parameter to decide for or against AVR. The prognostic role of NPs is improved if combined with clinical findings, comorbidities and surgical risk scores such as EuroSCORE.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Exercise testing in asymptomatic aortic stenosis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Patients with asymptomatic AS and abnormal hemodynamic responses to exercise testing are at increased risk for cardiac events. In asymptomatic or minimally symptomatic AS, higher plasma BNP levels are a better predictor of an abnormal blood pressure response to exercise than echocardiographic measures of aortic valve severity.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> In moderate to severe asymptomatic AS, BNP was associated with lower peak systolic velocity of the mitral valve annulus on exercise and reduced exercise capacity compared with controls.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Thus, in asymptomatic AS elevated BNP seems to reflect reduced myocardial functional reserve and is therefore indicative of LV dysfunction with exercise despite normal measures of systolic function at rest. Newer approaches, such as longitudinal LV strain by speckle tracking or tissue Doppler methods, may also reflect early worsening of LV function and have been shown to be related to BNP levels.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36,40</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Low-flow, low-gradient aortic stenosis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patients with severe AS and low cardiac output often present with a relatively low transvalvular pressure gradient (mean gradient less than 30<span class="elsevierStyleHsp" style=""></span>mmHg). Such patients can be difficult to distinguish from those with low cardiac output and only mild to moderate AS. In the former (true anatomically severe AS), the stenotic lesion contributes to elevated afterload, decreased ejection fraction, and low stroke volume. In the latter, primary contractile dysfunction is responsible for the decreased ejection fraction and low stroke volume. Dobutamine stress echocardiography is valuable in determining the actual severity of aortic valve stenosis and evaluating LV contractile reserve. Patients with LV dysfunction and low-flow, low-gradient AS, who account for 5%-10% of AS patients, represent the most challenging and controversial subset of patients to manage. These patients generally have a poor prognosis with conservative therapy, but high operative mortality if treated surgically. In the TOPAS (Truly or Pseudo-Severe Aortic Stenosis) study, BNP was higher in patients with truly severe compared with pseudo-severe AS and correlated with AS severity and LV ejection fraction.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> This may be caused by the more extensive LV afterload in patients with more severe AS. However, a large overlap of BNP levels was observed, and therefore BNP does not appear useful for determining the true severity of stenosis in the individual patient. The most important finding of this study was the relationship between BNP and survival in low-flow, low-gradient AS. With BNP levels ≥550 pg/ml, the cumulative 1-year survival of the total cohort compared with those with BNP levels <550 pg/ml was 47±9% vs. 97±3% (p<0.0001), and postoperative survival was 53±13% vs. 92±7%. Furthermore, high BNP levels predicted poor outcome independently of contractile reserve, defined by increase in stroke volume greater than 20% on dobutamine stress echocardiography.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">BNP levels, combined with clinical and echocardiographic parameters, may improve risk stratification in low-flow, low-gradient AS. Due to their high operative risk, these patients might be candidates for new surgical or catheter interventions, such as percutaneous aortic valve replacement or transapical valve implantation.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Transcatheter aortic valve implantation</span><p id="par0070" class="elsevierStylePara elsevierViewall">Transcatheter aortic valve implantation (TAVI) is a relatively recent technique developed to provide an alternative therapeutic solution for severe symptomatic AS patients at prohibitive or high surgical risk who are not candidates for AVR.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43,44</span></a> The indications for TAVI remain controversial. Despite the minimally invasive nature of the technique, significant clinical benefit and quality of life improvement,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> post-procedural complications and mortality remain high.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">46,47</span></a> Appropriate evaluation and risk stratification is needed to identify patients who would not succumb to comorbidities after TAVI. Present data suggests that NPs could be helpful in improving patient selection. Kefer et al.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> found that, in a TAVI population, a baseline BNP level >428 pg/ml was helpful for discriminating survival at 30 days. BNP levels (baseline and 24<span class="elsevierStyleHsp" style=""></span>hours after TAVI) were independent predictors of 30-day survival. Optimization of patients with evidence of high neurohormonal activation, by adjusting medical therapy or using percutaneous aortic balloon valvuloplasty,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> could be considered as a bridge therapy, to enable use of TAVI in stable hemodynamic conditions and hence to reduce periprocedural risk.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">After examining the evidence concerning neurohormonal assessment of AS, some further points need to be taken into consideration. Several conditions may result in increased NP levels,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> including coronary heart disease, atrial fibrillation, mitral regurgitation, severe respiratory disease, hypertrophic cardiomyopathy, and renal failure. These need to be considered when measuring NP levels in clinical practice in AS patients. Additionally, plasma NP levels increase with age and are higher in women than men after adjustment for age.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In AS, plasma NP levels are higher in symptomatic than in asymptomatic patients after adjustment for echocardiographic measures of aortic stenosis severity and LV function and increase with increasing severity of dyspnea and fatigue, but are not associated with angina or syncope. Measurement of plasma NP levels is likely to complement clinical and echocardiographic evaluation of AS patients for predicting outcome and stratifying risk. NPs appear to be helpful in evaluating asymptomatic AS and defining optimal timing for AVR, and also in selecting high surgical risk severe AS patients who are candidates for TAVI. However, prospective, randomized controlled trials are needed to confirm its value so that they can be integrated in routine clinical practice.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:17 [ 0 => array:2 [ "identificador" => "xres250833" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec238425" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres250834" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec238426" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Natriuretic peptides" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Natriuretic peptides in aortic stenosis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Severity of aortic stenosis" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Symptomatic status in aortic stenosis" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Outcome in severe unoperated aortic stenosis" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Postoperative outcome following aortic valve replacement" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Exercise testing in asymptomatic aortic stenosis" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Low-flow, low-gradient aortic stenosis" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Transcatheter aortic valve implantation" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 15 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 16 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-07-12" "fechaAceptado" => "2012-04-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec238425" "palabras" => array:4 [ 0 => "Aortic stenosis" 1 => "Natriuretic peptides" 2 => "BNP" 3 => "NT-proBNP" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec238426" "palabras" => array:4 [ 0 => "Estenose aortica" 1 => "Peptideos natriuréticos" 2 => "BNP" 3 => "NT-proBNP" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. Diagnosis, risk stratification and monitoring are usually based on clinical and echocardiographic parameters. Complementary methods are needed to improve management and outcome, particularly in patients with severe asymptomatic AS, whose management remains controversial. Natriuretic peptides (NPs) have established value as biomarkers in heart failure, coronary heart disease and pulmonary hypertension. This review discusses the usefulness and prognostic value of natriuretic peptides in AS. B-type natriuretic peptide (BNP) and its prohormone (NT-proBNP) correlate with disease severity, development of symptoms and prognosis, but before they can be routinely used in clinical practice, additional prospective studies are needed.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A estenose aórtica (EA) é a doença valvular mais prevalente em países desenvolvidos. O diagnóstico, a estratificação do risco e a monitorização são habitualmente baseados em parâmetros clínicos e ecocardiográficos. São necessários métodos complementares para melhorar a gestão e os resultados, particularmente nos doentes com EA grave assintomática, cuja abordagem permanece controversa. Os peptídeos natriuréticos (PN) demonstraram utilidade como biomarcadores na insuficiência cardíaca, cardiopatia isquémica e hipertensão pulmonar. Esta revisão pretende discutir a utilidade e valor prognóstico dos PN na AS. O Peptídeo natriurético do tipo B (BNP) e a sua prohormona (NT-proBNP) correlacionam-se com a gravidade da doença, desenvolvimento de sintomas e prognóstico, mas antes do seu uso por rotina na prática clínica, são necessários estudos prospetivos adicionais.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Bergler-Klein.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 760 "Ancho" => 1667 "Tamanyo" => 107079 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Release of BNP into the circulation from cardiac myocytes via precursor hormones. aa: amino acids.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Gerber et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1125 "Ancho" => 1573 "Tamanyo" => 72635 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Association between BNP levels and severity of aortic stenosis, showing BNP levels (median [upper quartile]) in normal controls and in subgroups of patients with aortic stenosis by aortic valve area, symptoms, and LV systolic function. AVA: aortic valve area; EF: ejection fraction.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:49 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burden of valvular heart diseases: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V.T. Nkomo" 1 => "J.M. Gardin" 2 => "T.N. Skelton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(06)69208-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2006" "volumen" => "368" "paginaInicial" => "1005" "paginaFinal" => "1011" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16980116" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valvular aortic stenosis: disease severity and timing of intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.M. Otto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2006.03.002" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2006" "volumen" => "47" "paginaInicial" => "2141" "paginaFinal" => "2151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16750677" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mitral valve repair in the treatment of mitral regurgitation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.A. Carabello" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Treat Options Cardiovasc Med" "fecha" => "2009" "volumen" => "11" "paginaInicial" => "419" "paginaFinal" => "425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19930979" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.O. Bonow" 1 => "B.A. Carabello" 2 => "K. Chatterjee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2008.05.007" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "e1" "paginaFinal" => "e142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18848134" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.A. Pellikka" 1 => "M.E. Sarano" 2 => "R.A. Nishimura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.104.495903" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "111" "paginaInicial" => "3290" "paginaFinal" => "3295" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15956131" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natriuretic peptides in common valvular heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.D. Steadman" 1 => "S. Ray" 2 => "L.L. Ng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2010.02.021" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2010" "volumen" => "55" "paginaInicial" => "2034" "paginaFinal" => "2048" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20447526" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "N-terminal pro-brain natriuretic peptide for discriminating between cardiac and non-cardiac dyspnoea" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.S. Nielsen" 1 => "J. Svanegaard" 2 => "N.A. Klitgaard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejheart.2003.10.003" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2004" "volumen" => "6" "paginaInicial" => "63" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15012920" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.W. Troughton" 1 => "C.M. Frampton" 2 => "T.G. Yandle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2000" "volumen" => "355" "paginaInicial" => "1126" "paginaFinal" => "1130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10791374" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "N-terminal pro-B-type natriuretic peptide complements the GRACE risk score in predicting early and late mortality following acute coronary syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.Q. Khan" 1 => "H. Narayan" 2 => "K.H. Ng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Sci (Lond)" "fecha" => "2009" "volumen" => "117" "paginaInicial" => "31" "paginaFinal" => "39" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma N-terminal B-type natriuretic peptide as an indicator of long-term survival after acute myocardial infarction: comparison with plasma midregional pro-atrial natriuretic peptide: the LAMP (Leicester Acute Myocardial Infarction Peptide) study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.Q. Khan" 1 => "O. Dhillon" 2 => "D. Kelly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2008.01.041" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2008" "volumen" => "51" "paginaInicial" => "1857" "paginaFinal" => "1864" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18466800" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Nagaya" 1 => "T. Nishikimi" 2 => "M. Uematsu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2000" "volumen" => "102" "paginaInicial" => "865" "paginaFinal" => "870" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10952954" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natriuretic peptides" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.B. Daniels" 1 => "A.S. Maisel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2007.09.021" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2007" "volumen" => "50" "paginaInicial" => "2357" "paginaFinal" => "2368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18154959" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biochemistry of B-type natriuretic peptide--where are we now?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Mair" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1515/CCLM.2008.295" "Revista" => array:6 [ "tituloSerie" => "Clin Chem Lab Med" "fecha" => "2008" "volumen" => "46" "paginaInicial" => "1507" "paginaFinal" => "1514" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18842106" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Distinct downregulation of C-type natriuretic peptide system in human aortic valve stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.O. Peltonen" 1 => "P. Taskinen" 2 => "Y. Soini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.106.685743" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2007" "volumen" => "116" "paginaInicial" => "1283" "paginaFinal" => "1289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17709640" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natriuretic peptides in the management of aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Bergler-Klein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Cardiol Rep" "fecha" => "2009" "volumen" => "11" "paginaInicial" => "85" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19236823" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natriuretic peptides in patients with aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Qi" 1 => "P. Mathisen" 2 => "J. Kjekshus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mhj.2001.117131" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2001" "volumen" => "142" "paginaInicial" => "725" "paginaFinal" => "732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11579366" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brain natriuretic peptide concentrations in patients with aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Prasad" 1 => "A.B. Bridges" 2 => "C.C. Lang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am Heart J" "fecha" => "1997" "volumen" => "133" "numero" => "4" "paginaInicial" => "477" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9124176" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Vanderheyden M, Goethals M, Verstreken S, De Bruyne B, Muller K, Van Schuerbeeck E, et al. Wall stress modulates brain natriuretic peptide production in pressure overload cardiomyopathy. J Am Coll Cardiol. 2004;44:2349–54." ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Iwanaga" 1 => "I. Nishi" 2 => "S. Furuichi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2005.11.030" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2006" "volumen" => "47" "paginaInicial" => "742" "paginaFinal" => "748" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16487838" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma levels of brain and atrial natriuretic peptides elevate in proportion to left ventricular end-systolic wall stress in patients with aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Ikeda" 1 => "K. Matsuda" 2 => "H. Itoh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "1997" "volumen" => "133" "paginaInicial" => "307" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9060799" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation of N-terminal pro-B-type natriuretic peptide to severity of valvular aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Weber" 1 => "R. Arnold" 2 => "M. Rau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2004.05.055" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2004" "volumen" => "94" "paginaInicial" => "740" "paginaFinal" => "745" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15374777" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptide" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Lim" 1 => "J.L. Monin" 2 => "M. Monchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ehj.2004.09.033" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "2048" "paginaFinal" => "2053" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15541842" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Bergler-Klein" 1 => "U. Klaar" 2 => "M. Heger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000126825.50903.18" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2004" "volumen" => "109" "paginaInicial" => "2302" "paginaFinal" => "2308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15117847" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum gamma-glutamyltransferase activity is increased in patients with calcific aortic valve stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Bozbas" 1 => "A. Yildirir" 2 => "O. Demir" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Heart Valve Dis" "fecha" => "2008" "volumen" => "17" "paginaInicial" => "371" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18751465" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I.L. Gerber" 1 => "R.A. Stewart" 2 => "M.E. Legget" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000060533.79248.0C" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2003" "volumen" => "107" "paginaInicial" => "1884" "paginaFinal" => "1890" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12668523" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Weber" 1 => "R. Arnold" 2 => "M. Rau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehi236" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "1023" "paginaFinal" => "1030" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15781428" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart failure in patients with aortic stenosis: clinical and prognostic significance of carbohydrate antigen 125 and brain natriuretic peptide measurement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Antonini-Canterin" 1 => "B.A. Popescu" 2 => "A.C. Popescu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2007.05.039" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2008" "volumen" => "128" "paginaInicial" => "406" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17662495" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of serial measurement of N-terminal pro-brain natriuretic peptide plasma levels in asymptomatic patients with aortic stenosis to predict symptomatic deterioration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I.L. Gerber" 1 => "M.E. Legget" 2 => "T.M. West" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2004.11.053" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2005" "volumen" => "95" "paginaInicial" => "898" "paginaFinal" => "901" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15781029" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of an elevated B-type natriuretic peptide in predicting survival in patients with aortic stenosis treated without surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.G. Nessmith" 1 => "H. Fukuta" 2 => "S. Brucks" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2005.06.092" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "1445" "paginaFinal" => "1448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16275196" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in-hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.B. Pedrazzini" 1 => "S. Masson" 2 => "R. Latini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2008.04.055" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2008" "volumen" => "102" "paginaInicial" => "749" "paginaFinal" => "754" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18774001" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of outcome in severe, asymptomatic aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Rosenhek" 1 => "T. Binder" 2 => "G. Porenta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200008313430903" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2000" "volumen" => "343" "paginaInicial" => "611" "paginaFinal" => "617" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10965007" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.A. Pellikka" 1 => "R.A. Nishimura" 2 => "K.R. Bailey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "1990" "volumen" => "15" "paginaInicial" => "1012" "paginaFinal" => "1017" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2312954" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changes in type B natriuretic peptide (BNP) concentrations during cardiac valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Georges" 1 => "F. Forestier" 2 => "N. Valli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2004.02.029" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "941" "paginaFinal" => "945" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15144992" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative changes in atrial natriuretic peptide plasma levels associated with mitral and aortic valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Kostopanagiotou" 1 => "E. Apostolakis" 2 => "K. Theodoraki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2004" "volumen" => "18" "paginaInicial" => "30" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14973795" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1052305710001047" "estado" => "S300" "issn" => "10523057" ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of aortic valve replacement on plasma B-type natriuretic peptide in patients with severe aortic stenosis--one year follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N.O. Neverdal" 1 => "C.W. Knudsen" 2 => "T. Husebye" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejheart.2005.08.004" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2006" "volumen" => "8" "paginaInicial" => "257" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16466963" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recovery of left ventricular systolic longitudinal strain after valve replacement in aortic stenosis and relation to natriuretic peptides" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.H. Poulsen" 1 => "P. Sogaard" 2 => "J.E. Nielsen-Kudsk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.echo.2006.11.020" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "2007" "volumen" => "20" "paginaInicial" => "877" "paginaFinal" => "884" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17617315" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of aortic valve replacement on N-terminal natriuretic propeptides in patients with aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Qi" 1 => "P. Mathisen" 2 => "J. Kjekshus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Cardiol" "fecha" => "2002" "volumen" => "25" "paginaInicial" => "174" "paginaFinal" => "180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12000075" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased B-type natriuretic peptide is associated with an abnormal blood pressure response to exercise in asymptomatic aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N.C. Van Pelt" 1 => "A.J. Kerr" 2 => "M.E. Legget" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2007.07.172" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2008" "volumen" => "127" "paginaInicial" => "313" "paginaFinal" => "320" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18077013" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Longitudinal left ventricular contractile dysfunction after exercise in aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N.C. Van Pelt" 1 => "R.A. Stewart" 2 => "M.E. Legget" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/hrt.2006.100164" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2007" "volumen" => "93" "paginaInicial" => "732" "paginaFinal" => "738" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17090563" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "B-type natriuretic peptide and tissue doppler for predicting symptoms on treadmill exercise in apparently asymptomatic aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Rajani" 1 => "H. Rimington" 2 => "J. Chambers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Heart Valve Dis" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "565" "paginaFinal" => "571" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20099699" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "B-type natriuretic peptide in low-flow, low-gradient aortic stenosis: relationship to hemodynamics and clinical outcome: results from the Multicenter Truly or Pseudo-Severe Aortic Stenosis (TOPAS) study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Bergler-Klein" 1 => "G. Mundigler" 2 => "P. Pibarot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.106.654210" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2007" "volumen" => "115" "paginaInicial" => "2848" "paginaFinal" => "2855" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17515464" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transapical minimally invasive aortic valve implantation; the initial 50 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Walther" 1 => "V. Falk" 2 => "J. Kempfert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2008.01.046" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2008" "volumen" => "33" "paginaInicial" => "983" "paginaFinal" => "988" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18294859" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.G. Webb" 1 => "L. Altwegg" 2 => "R.H. Boone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.108.837807" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2009" "volumen" => "119" "paginaInicial" => "3009" "paginaFinal" => "3016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19487594" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Progress and current status of percutaneous aortic valve replacement: results of three device generations of the CoreValve Revalving system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Grube" 1 => "L. Buellesfeld" 2 => "R. Mueller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCINTERVENTIONS.108.819839" "Revista" => array:6 [ "tituloSerie" => "Circ Cardiovasc Interv" "fecha" => "2008" "volumen" => "1" "paginaInicial" => "167" "paginaFinal" => "175" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20031675" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term effects of transcatheter aortic valve implantation on neurohormonal activation, quality of life and 6-minute walk test in severe and symptomatic aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Gotzmann" 1 => "T. Hehen" 2 => "A. Germing" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/hrt.2009.180661" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2010" "volumen" => "96" "paginaInicial" => "1102" "paginaFinal" => "1106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19884109" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.B. Leon" 1 => "C.R. Smith" 2 => "M. Mack" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1008232" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "363" "paginaInicial" => "1597" "paginaFinal" => "1607" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20961243" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter versus surgical aortic-valve replacement in high-risk patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.R. Smith" 1 => "M.B. Leon" 2 => "M.J. Mack" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1103510" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "2187" "paginaFinal" => "2198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21639811" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of B-type natriuretic peptide to predict outcome of patients treated by transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Kefer" 1 => "C. Beauloye" 2 => "P. Astarci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2010.07.051" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2010" "volumen" => "106" "paginaInicial" => "1782" "paginaFinal" => "1786" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21055712" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous balloon aortic valvuloplasty revisited: time for a renaissance?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Hara" 1 => "W.R. Pedersen" 2 => "E. Ladich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.106.657098" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2007" "volumen" => "115" "paginaInicial" => "e334" "paginaFinal" => "e338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17389271" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003100000010/v1_201308021325/S0870255112001746/v1_201308021325/en/main.assets" "Apartado" => array:4 [ "identificador" => "14881" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Artigo de Revisão" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003100000010/v1_201308021325/S0870255112001746/v1_201308021325/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255112001746?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 6 | 6 | 12 |
| 2024 Outubro | 42 | 19 | 61 |
| 2024 Setembro | 58 | 24 | 82 |
| 2024 Agosto | 56 | 31 | 87 |
| 2024 Julho | 43 | 28 | 71 |
| 2024 Junho | 53 | 25 | 78 |
| 2024 Maio | 79 | 21 | 100 |
| 2024 Abril | 39 | 26 | 65 |
| 2024 Maro | 35 | 13 | 48 |
| 2024 Fevereiro | 41 | 25 | 66 |
| 2024 Janeiro | 31 | 22 | 53 |
| 2023 Dezembro | 23 | 24 | 47 |
| 2023 Novembro | 35 | 27 | 62 |
| 2023 Outubro | 30 | 17 | 47 |
| 2023 Setembro | 42 | 20 | 62 |
| 2023 Agosto | 22 | 16 | 38 |
| 2023 Julho | 24 | 12 | 36 |
| 2023 Junho | 28 | 15 | 43 |
| 2023 Maio | 42 | 25 | 67 |
| 2023 Abril | 18 | 5 | 23 |
| 2023 Maro | 39 | 23 | 62 |
| 2023 Fevereiro | 29 | 22 | 51 |
| 2023 Janeiro | 23 | 14 | 37 |
| 2022 Dezembro | 44 | 19 | 63 |
| 2022 Novembro | 50 | 24 | 74 |
| 2022 Outubro | 27 | 18 | 45 |
| 2022 Setembro | 31 | 36 | 67 |
| 2022 Agosto | 36 | 30 | 66 |
| 2022 Julho | 37 | 41 | 78 |
| 2022 Junho | 21 | 20 | 41 |
| 2022 Maio | 29 | 42 | 71 |
| 2022 Abril | 29 | 25 | 54 |
| 2022 Maro | 24 | 35 | 59 |
| 2022 Fevereiro | 28 | 24 | 52 |
| 2022 Janeiro | 65 | 24 | 89 |
| 2021 Dezembro | 27 | 34 | 61 |
| 2021 Novembro | 37 | 45 | 82 |
| 2021 Outubro | 38 | 43 | 81 |
| 2021 Setembro | 28 | 22 | 50 |
| 2021 Agosto | 25 | 26 | 51 |
| 2021 Julho | 25 | 29 | 54 |
| 2021 Junho | 25 | 20 | 45 |
| 2021 Maio | 25 | 32 | 57 |
| 2021 Abril | 35 | 48 | 83 |
| 2021 Maro | 57 | 11 | 68 |
| 2021 Fevereiro | 53 | 12 | 65 |
| 2021 Janeiro | 19 | 14 | 33 |
| 2020 Dezembro | 25 | 3 | 28 |
| 2020 Novembro | 38 | 19 | 57 |
| 2020 Outubro | 49 | 12 | 61 |
| 2020 Setembro | 69 | 15 | 84 |
| 2020 Agosto | 37 | 5 | 42 |
| 2020 Julho | 42 | 13 | 55 |
| 2020 Junho | 43 | 8 | 51 |
| 2020 Maio | 48 | 5 | 53 |
| 2020 Abril | 46 | 9 | 55 |
| 2020 Maro | 43 | 7 | 50 |
| 2020 Fevereiro | 65 | 14 | 79 |
| 2020 Janeiro | 37 | 3 | 40 |
| 2019 Dezembro | 44 | 4 | 48 |
| 2019 Novembro | 28 | 7 | 35 |
| 2019 Outubro | 38 | 6 | 44 |
| 2019 Setembro | 32 | 28 | 60 |
| 2019 Agosto | 25 | 1 | 26 |
| 2019 Julho | 36 | 11 | 47 |
| 2019 Junho | 35 | 4 | 39 |
| 2019 Maio | 39 | 7 | 46 |
| 2019 Abril | 24 | 12 | 36 |
| 2019 Maro | 76 | 9 | 85 |
| 2019 Fevereiro | 73 | 13 | 86 |
| 2019 Janeiro | 32 | 3 | 35 |
| 2018 Dezembro | 43 | 12 | 55 |
| 2018 Novembro | 187 | 19 | 206 |
| 2018 Outubro | 559 | 24 | 583 |
| 2018 Setembro | 158 | 20 | 178 |
| 2018 Agosto | 45 | 15 | 60 |
| 2018 Julho | 46 | 10 | 56 |
| 2018 Junho | 67 | 12 | 79 |
| 2018 Maio | 51 | 19 | 70 |
| 2018 Abril | 67 | 11 | 78 |
| 2018 Maro | 59 | 15 | 74 |
| 2018 Fevereiro | 36 | 3 | 39 |
| 2018 Janeiro | 39 | 4 | 43 |
| 2017 Dezembro | 69 | 8 | 77 |
| 2017 Novembro | 57 | 9 | 66 |
| 2017 Outubro | 50 | 6 | 56 |
| 2017 Setembro | 45 | 16 | 61 |
| 2017 Agosto | 82 | 19 | 101 |
| 2017 Julho | 35 | 11 | 46 |
| 2017 Junho | 55 | 10 | 65 |
| 2017 Maio | 36 | 16 | 52 |
| 2017 Abril | 28 | 4 | 32 |
| 2017 Maro | 32 | 4 | 36 |
| 2017 Fevereiro | 44 | 7 | 51 |
| 2017 Janeiro | 40 | 5 | 45 |
| 2016 Dezembro | 44 | 11 | 55 |
| 2016 Novembro | 43 | 7 | 50 |
| 2016 Outubro | 33 | 14 | 47 |
| 2016 Setembro | 13 | 5 | 18 |
| 2016 Agosto | 8 | 3 | 11 |
| 2016 Julho | 5 | 3 | 8 |
| 2016 Junho | 4 | 5 | 9 |
| 2016 Maio | 5 | 9 | 14 |
| 2016 Abril | 43 | 3 | 46 |
| 2016 Maro | 68 | 17 | 85 |
| 2016 Fevereiro | 78 | 23 | 101 |
| 2016 Janeiro | 68 | 20 | 88 |
| 2015 Dezembro | 67 | 7 | 74 |
| 2015 Novembro | 93 | 11 | 104 |
| 2015 Outubro | 66 | 8 | 74 |
| 2015 Setembro | 80 | 9 | 89 |
| 2015 Agosto | 76 | 14 | 90 |
| 2015 Julho | 68 | 14 | 82 |
| 2015 Junho | 55 | 3 | 58 |
| 2015 Maio | 58 | 8 | 66 |
| 2015 Abril | 59 | 12 | 71 |
| 2015 Maro | 67 | 4 | 71 |
| 2015 Fevereiro | 56 | 3 | 59 |
| 2015 Janeiro | 45 | 11 | 56 |
| 2014 Dezembro | 66 | 10 | 76 |
| 2014 Novembro | 50 | 8 | 58 |
| 2014 Outubro | 63 | 11 | 74 |
| 2014 Setembro | 61 | 11 | 72 |
| 2014 Agosto | 54 | 10 | 64 |
| 2014 Julho | 62 | 8 | 70 |
| 2014 Junho | 62 | 7 | 69 |
| 2014 Maio | 58 | 9 | 67 |
| 2014 Abril | 72 | 11 | 83 |
| 2014 Maro | 104 | 19 | 123 |
| 2014 Fevereiro | 89 | 22 | 111 |
| 2014 Janeiro | 75 | 13 | 88 |
| 2013 Dezembro | 68 | 13 | 81 |
| 2013 Novembro | 85 | 15 | 100 |
| 2013 Outubro | 78 | 15 | 93 |
| 2013 Setembro | 71 | 20 | 91 |
| 2013 Agosto | 65 | 20 | 85 |
| 2013 Julho | 84 | 32 | 116 |
| 2013 Junho | 92 | 22 | 114 |
| 2013 Maio | 82 | 31 | 113 |
| 2013 Abril | 87 | 53 | 140 |
| 2013 Maro | 70 | 38 | 108 |
| 2013 Fevereiro | 82 | 49 | 131 |
| 2013 Janeiro | 85 | 41 | 126 |
| 2012 Dezembro | 64 | 33 | 97 |
| 2012 Novembro | 57 | 46 | 103 |
| 2012 Outubro | 81 | 55 | 136 |
Mostrar tudo
