Change of B-type natriuretic peptide after surgery and its association with rhythm status in patients with chronic severe mitral regurgitation.

Abstract

BACKGROUND:

B-type natriuretic peptide (BNP) is a useful biomarker of cardiac function in patients with mitral regurgitation (MR). However, the change in BNP in association with rhythm status after corrective surgery has not been studied.

METHODS:

A total of 101 patients with chronic severe MR undergoing surgery were prospectively enrolled. BNP assays and echocardiographic studies were conducted before and 6 months after surgery. Patients were divided into 3 groups according to pre- and postoperative rhythm (sinus to sinus [SS], n = 61; atrial fibrillation [AF] to sinus [AS], n = 28; AF to AF [AA], n = 12).

RESULTS:

BNP decreased only in the AS group 6 months after mitral surgery (from 218.0 ± 136.5 to 94.7 ± 85.1 pg/mL; P < 0.001) but not in the SS or AA groups (P for interaction = 0.001). However, changes of echocardiographic parameters after surgery were not different among the 3 groups. In the AA group, postoperative left ventricular (LV) end-diastolic dimension and left atrial volume were higher than the other groups. Significant determinants of BNP were the presence of AF and the higher pulmonary artery systolic pressure preoperatively (β = 0.767 and P = 0.001 for AF; β = 0.022 and P = 0.019 for pulmonary artery systolic pressure), and the lower LV ejection fraction postoperatively (β = -0.030; P = 0.011).

CONCLUSIONS:

After surgical correction of chronic organic severe MR, BNP decreased only in patients with preoperative AF which was converted to sinus rhythm postoperatively. A reduction in BNP was not observed when rhythm status did not change. BNP activation was associated with the presence of AF and LV systolic dysfunction, suggesting its prognostic value.

• Authors: In-Chang Hwang, Dae-Hee Kim, Yong-Jin Kim, Kyung-Hee Kim, Seung-Pyo Lee, Hyung-Kwan Kim, Dae-Won Sohn, Byung-Hee Oh, Young-Bae Park
• Journal: The Canadian journal of cardiology (Can J Cardiol) Vol. 29 Issue 6 Pg. 704-11 (Jun 2013) ISSN: 1916-7075 [Electronic] England
• PMID: 23218467 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Natriuretic Peptide, Brain

Topics

• Biomarkers (blood)
• Chronic Disease
• Echocardiography, Doppler
• Female
• Follow-Up Studies
• Heart Rate
• Heart Valve Prosthesis
• Heart Ventricles (diagnostic imaging, physiopathology)
• Humans
• Male
• Middle Aged
• Mitral Valve Insufficiency (blood, physiopathology, surgery)
• Natriuretic Peptide, Brain (blood)
• Postoperative Period
• Prognosis
• Prospective Studies
• Severity of Illness Index
• Ventricular Function, Left (physiology)