Background and Objectives: Moderate aortic stenosis (AS) confers a surprisingly adverse prognosis, approaching that of severe AS. The objective of this study was to describe the clinical course of patients with moderate AS with evidence of concomitant heart failure manifesting as elevated brain natriuretic peptide (BNP) levels. Methods: This is a single-center, retrospective cohort study of 332 patients with elevated BNP. 165 patients with moderate AS were compared with 167 controls with none-mild AS.The Median follow-up duration was 3.85 years. The primary outcome was a composite endpoint of all-cause hospitalizations and all-cause mortality. Results: BNP levels were 530 and 515 pg/mL in the study and the control groups, respectively. Moderate AS had significantly higher rates of primary composite endpoint in both univariate analysis (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.14–1.97; p=0.004) and adjusted analysis (HR, 1.45; 95% CI, 1.05–2.01; p=0.02). Moderate AS had 1.41 (95% CI, 1.18– 1.69; p<0.001) times more all-cause hospitalization per patient-year of follow-up compared to controls in the univariate model. After adjustment for significant covariates, moderate AS remained an independent predictor of all-cause hospitalizations (incidence rate ratio [IRR], 1.45; 95% CI, 1.18–1.79; p=0.005). Furthermore, moderate AS was significantly associated with higher all-cause hospitalization rates in both heart failure with reduced ejection fraction (IRR, 1.33; 95% CI, 1.02–1.75; p=0.038) and heart failure with preserved ejection fraction [IRR], 1.31; 95% CI, 1.03–1.67; p=0.026). Conclusions Moderate AS in conjunction with elevated BNP portends a significantly worse prognosis than those without moderate AS and should be followed closely.

Objective:Granules of herbal extracts are a popular medicinal preparation consumed in traditional Chinese medicine clinical practice.However,their quality and efficacy evaluation are lacking.This study aimed to compare the quality and anti-oxidant activity of Dan Shen(Salvia miltiorrhiza Radix&Rhizoma)granule extracts with their herbal extracts.Methods:Chromatographic method was used to determine the content of 7 marker compounds in the water extracts of the herb compared to that of 12 granule extracts.Agglomerative hierarchical clustering(AHC)and principal component analysis(PCA)distinguished the herbal and granule extracts based on the content of the marker compounds.The antioxidant activities of herbal and granule extracts were evaluated by 2,2'-azino-bis(3-ethylbenz-thiazoline-6-sulfonic acid)(ABTS),organic chemical compound 2,2-diphenyl-1-picrylhydrazyl(DPPH)and ferric ion reducing antioxidant power(FRAP)assays.Results:The herbal extracts group showed significantly higher contents of salvianolic acid B,sodium danshensu and cryptotanshinone compared with that of the granule group.This corresponded to significantly higher ABTS,DPPH and FRAP(P＜.05)activities of the herbal extracts.The AHC and PCA analysis distinguished granule extracts from most herbal extracts predominantly by the content of sal-vianolic acid B.Conclusion:The results confirm the need for the assessment of granule products so that healthcare practitioners and consumers are better informed of their quality and efficacy.