Brain Natriuretic Peptide and the Severity of Aortic Regurgitation: Is There Any Correlation?

Özkan, Mustafa; Baysan, Oben; Erınç, Kürşad; Köz, Cem; Yokusoglu, M.; Uzun, Mehmet; Sağ, Cemal; Genç, Celal; Karaeren, Hayrettin; Işık, Ersoy

doi:10.1177/147323000503300411

Cited by 7 publications

(4 citation statements)

References 29 publications

(17 reference statements)

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“…The data from this study support this hypothesis. Increasing emphasis has been placed on myocardial biology to compensate for the prognostic inadequacies of conventional size and performance descriptors in AR [47][48][49][50]; intrinsic contractility may prove an integrator of these various biological responses.…”

Section: Discussionmentioning

confidence: 99%

Survival after Aortic Valve Replacement for Aortic Regurgitation: Prediction from Preoperative Contractility Measurement

et al. 2018

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Background: Noninvasive measurement of myocardial contractility (end-systolic wall stress-adjusted change in left ventricular ejection fraction from rest to exercise [ΔLVEF – ΔESS]) predicts heart failure, subnormal LVEF_rest, and sudden death in asymptomatic patients with chronic severe aortic regurgitation (AR). Here we assess the relation of preoperative ΔLVEF – ΔESS to survival after aortic valve replacement (AVR). Methods: Patients who underwent AVR for chronic, isolated, pure severe AR (n = 66) were followed for 13.0 ± 6.4 event-free years. Preoperative ΔLVEF – ΔESS (from combined echocardiographic and radionuclide cineangiographic data) enabled cohort stratification into 3 terciles (–1 to –11% [normal or mild] contractility deficit, –12 to –16% [moderate], and ≤–17% [severe], identical with segregation in our earlier study) to relate preoperative contractility to postoperative survival and to age- and gender-matched US census data. Results: Since AVR, 22 patients died (average annual risk [AAR] for all-cause mortality for the entire co hort = 3.15%). Preoperative ΔLVEF – ΔESS predicted postoperative survival (p = 0.009, log rank test). By contractility terciles, all-cause AARs were 1.44, 2.58, and 6.40%. Survival was lower than among US census comparators (p < 0.02), but the “mild” tercile was indistinguishable from census data (p = ns). By multivariable Cox regression, survival prediction by pre-AVR ΔLVEF – ΔESS was independent of, and superior to, prediction by age at surgery, gender, preoperative functional class, LVEF_rest, LVEF_exercise, change in LVEF_{rest to exercise}, and LV diastolic or systolic dimensions (p ≤ 0.01, pre-AVR ΔLVEF – ΔESS vs. other covariates). Conclusion: In severe AR, preoperative contractility predicts post-AVR survival and may be prognostically superior to clinical, geometric and performance descriptors, potentially impacting on patient selection for surgery.

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Section: Discussionmentioning

confidence: 99%

Survival after Aortic Valve Replacement for Aortic Regurgitation: Prediction from Preoperative Contractility Measurement

et al. 2018

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“…Interestingly, in our study, the post-TAVR serum BNP was significantly associated with residual PVL and MR as well as with higher PHT and lower EF, all of which were previously implicated to be associated with elevated BNP serum levels and worse prognosis [56-58]. It seems that post-procedural serum BNP may incorporate several post-TAVR residual hemodynamic known prognostic post-TAVR parameters [24, 48, 59, 60], each by itself reflecting the combined hemodynamic prognostic profile, and all of which elevated post-TAVR serum BNP levels.…”

Section: Discussionmentioning

confidence: 55%

Pre- and Post-Transcatheter Aortic Valve Replacement Serum Brain Natriuretic Peptide Levels and All-Cause Mortality

et al. 2020

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Background: Risk stratification in patients post-transcatheter aortic valve replacement (TAVR) is limited to and is based on clinical judgment and surgical scoring systems. Serum natriuretic peptides are used for general risk stratification in patients with aortic stenosis, reflecting the increase in their afterload and thereby stressing the need for valve intervention. The objective of this study was to determine the predictive value of pre- and post-procedural serum brain natriuretic peptide (BNP) on 1-year all-cause mortality in patients who underwent TAVR. Methods: In this population-based study, we included 148 TAVR patients treated at the Poriya Medical Center between June 1, 2015, and May 31, 2018. Routine blood samples for serum BNP levels (pg/mL) were taken just before the TAVR and 24 h post-TAVR. Our primary clinical outcome was defined as 1-year all-cause mortality. We used backward regression models and included all variables that had a p value <0.1 in the univariable analysis. A receiver-operating characteristic curve was calculated for the prediction of all-cause mortality by serum BNP levels using the median as the cut-off point. Results: In this study cohort, BNP levels 24 h post-TAVR higher than the cohort median versus lower than the cohort median (387.5 pg/mL; IQR 195–817.6) were the strongest predictor of 1-year mortality (hazard ratio 9; 95% CI 2.72–30.16; p < 0.001). The statistically significant relationship was seen in the unadjusted regression model as well as after the adjustment for clinical variables. Conclusions: Serum BNP levels 24 h post-procedure were found to be a meaningful marker in predicting 1-year all-cause mortality in patients after TAVR procedure.

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“…The correlation between serum levels and valve lesion severity and left ventricular dysfunction is, however, less clear. In a group of 60 patients with a mean age of 22 years, it was found that levels increased with an increase in valvular regurgitant severity as defi ned by the diameter of the vena contracta (27) -levels increased even in mild AR (despite no difference in LV end-diastolic diameter compared to control), and were highest in severe AR. These results suggest that serum levels do refl ect valve lesion severity.…”

Section: Aortic Valve Regurgitation (Ar)mentioning

confidence: 99%

“…(25)(26)(27) BNP and NT-proBNP levels are signifi cantly increased in subjects with AR, even in those who are asymptomatic. The correlation between serum levels and valve lesion severity and left ventricular dysfunction is, however, less clear.…”

Section: Aortic Valve Regurgitation (Ar)mentioning

confidence: 99%

Serum brain natriuretic peptide (BNP) and N-terminal brain natriuretic peptide (NT-proBNP) in heart valve disease

Moolman

Preez

Rossouw

2017

SAHJ

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Serum levels of natriuretic peptides (BNP and NT-proBNP) are known to increase in cardiac failure, and aid in the diagnosis and management of such patients. BNP and NT-proBNP also increase in patients with heart valve lesions, and may contribute to the assessment and management of these patients. There appears to be a general trend towards higher BNP values in more severe heart valve lesions, but the exact implication of a raised BNP or NTproBNP appears to be different for each specifi c valve lesion. In aortic valve stenosis increased levels of BNP/NT-proBNP correlate with the degree of stenosis, symptoms and prognosis. In addition, the increased natriuretic peptide levels seem to refl ect left ventricular dysfunction, as high levels predict poor long-term outcomes in conservatively treated patients as well as post-operative death and poor functional recovery in those who survive the valve replacement procedure. In mitral regurgitation natriuretic peptide levels correlate with the degree of valvular regurgitation, and seem to refl ect subclinical left ventricular dysfunction. Serum natriuretic peptide levels are elevated in patients with mitral stenosis, and correlate with the degree of valvular stenosis and increased pulmonary pressure. Serum levels of natriuretic peptides are elevated in other heart valve lesions, such as aortic valve regurgitation, as well as different forms of mixed valvular disease, but very little is ABSTRACT BNP AND NT-proBNP IN HEART VALVE DISEASE known about the relationship between the serum levels of natriuretic peptides and the latter valve lesions. The practical application of our knowledge concerning serum natriuretic peptides and heart valve disease is limited at this stage, and no specifi c cut-off values to guide patient management have been incorporated into any offi cial guidelines as yet. This review aims to summarise current knowledge on serum BNP and NT-proBNP levels in patients with heart valve disease. The impact of this information on current clinical decision making in patients with different heart valve lesions, as well as evolving concepts concerning its potential future use, will be discussed.

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Brain Natriuretic Peptide and the Severity of Aortic Regurgitation: Is There Any Correlation?

Cited by 7 publications

References 29 publications

Survival after Aortic Valve Replacement for Aortic Regurgitation: Prediction from Preoperative Contractility Measurement

Survival after Aortic Valve Replacement for Aortic Regurgitation: Prediction from Preoperative Contractility Measurement

Pre- and Post-Transcatheter Aortic Valve Replacement Serum Brain Natriuretic Peptide Levels and All-Cause Mortality

Serum brain natriuretic peptide (BNP) and N-terminal brain natriuretic peptide (NT-proBNP) in heart valve disease

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