N-terminal pro-BNP plasma levels before and after percutaneous transvenous mitral commissurotomy for mitral stenosis

Chadha, D.S.; Karthikeyan, Ganesan; Goel, Kashish; Malani, Sushil K.; Seth, Sandeep; Singh, Sandeep; Dhall, Anil; Bhargava, Balram

doi:10.1016/j.ijcard.2009.01.001

Cited by 9 publications

(12 citation statements)

References 7 publications

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“…In concordance to other studies 6 , 7 NT-Pro BNP levels show a significant reduction in patients after undergoing successful PTMC. The reduction correlated well with the decline observed in mean LAP and PAP.…”

Section: Discussionsupporting

confidence: 92%

“…NT-Pro BNP levels in the peripheral blood are reported to decrease one day after successful PTMC. 6 , 7 Since changes in biomarker levels in LA precede serum changes, we postulated that LA sampling could provide an early indication for the success of the procedure and could offer immediate guidance for predicting favourable results. We sought to evaluate the BNP levels from left atrium (LA) before and 20 minutes after the procedure and serum NT-pro BNP levels before and 24 hours after the procedure and examine the correlation with hemodynamic outcomes of PTMC.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Serum NT-Pro BNP and Left Atrial BNP Levels after Percutaneous Transvenous Mitral Commissurotomy in Sinus Rhythm Versus Atrial Firilation

Pourafkari¹,

Seyedhosseini²,

Kazemi³

et al. 2014

J Cardiovasc Thorac Res

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Introduction: Natriuretic peptides are secreted from the heart in response to increased wall stress. Their levels are expected to be increased in patients with mitral stenosis (MS) due to high left atrium (LA) pressure and pulmonary artery pressure (PAP). Percutaneous transvenous mitral commissurotomy (PTMC) if successful is pursued by a rapid decrease in LA pressure and subsequent decrease in pulmonary artery pressure. The concurrent changes in natriuretic peptide levels could be affected with heart rhythm. Methods: Forty five patients with severe rheumatic MS undergoing PTMC were enrolled. We evaluated the serum NT-Pro BNP levels before and 24 hours after PTMC. BNP levels were also measured from the blood samples obtained from LA before and 20 minutes after the procedure. Changes in biomarkers were assessed based on heart rhythm and success of the procedure. Results: While serum NT-Pro BNP levels showed significant decrease 24 hours after the procedure (P= 0.04), BNP levels taken 20 minutes after PTMC from LA were similar to their baseline concentrations (P= 0.26). NT-Pro BNP levels decreased 51.7±182.86 pg/ml for sinus rhythm (SR) and 123.4±520 pg/ml for atrial fibrillation (AF) (P= 0.68). Conclusion: Immediate changes in BNP levels did not predict the success of procedure probably due to the additional balloon inflation attempts in LA in several patients and half-life of BNP. BNP levels obtained later may be of more value considering the half-life of this marker. Heart rhythm was not found to influence the changes in biomarker levels. BNP and NT-pro BNP changes were not found to predict success of the procedure.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Changes in Serum NT-Pro BNP and Left Atrial BNP Levels after Percutaneous Transvenous Mitral Commissurotomy in Sinus Rhythm Versus Atrial Firilation

Pourafkari¹,

Seyedhosseini²,

Kazemi³

et al. 2014

J Cardiovasc Thorac Res

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“…As the last point, lower change in PAP as well as higher change in NT-pro-BNP is predicted following PTMC in the group with AF compared to those with normal sinus rhythm in our study; this finding is relatively different from the findings of some other studies [21,22]. Future studies with large sample size and powerful meta-analysis will reveal more detailed and clear results.…”

Section: Discussioncontrasting

confidence: 98%

The change in NT-pro-BNP and post-PTMC echocardiography parameters in patients with mitral stenosis. A pilot study

Safi

Bayat

Ahmadi

et al. 2017

Romanian Journal of Internal Medicine

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Background. The change in the level of NT-pro-BNP (N-terminal-pro-Brain Natriuretic Peptide) is now considered as a reflection of the hemodynamic alterations and its circulatory reductions reported early after successful PTMC (percutaneous transvenous mitral commissurotomy). The present study aims to assess the change in the level of NT-pro BNP following PTMC in patients with mitral stenosis and also to determine the association between circulatory NT-pro-BNP reduction and post-PTMC echocardiography parameters. Methods. Twenty five symptomatic consecutive patients with severe MS undergoing elective PTMC were prospectively enrolled. All patients underwent echocardiography before and also 24 to 48 hours after PTMC. Peripheral blood samples were taken for measurement of NT-pro-BNP before as well as 24 to 48 hours after PTMC. The patients were also classified in group with normal sinus rhythm or having atrial fibrillation (AF) based on their 12-lead electrocardiogram. Results. It was shown a significant decrease in the parameters of PPG (Peak Pressure Gradient), MPG (Mean Pressure Gradient), PHT (Pressure Half Time), PAP (Pulmonary Arterial Pressure), LAV (Left Atrial Volume), and also a significant increase in MVA (Mitral Valve Area) RVS (Right Ventricular S velocity), and strains of lateral, septal, inferior and anterior walls of LA following PTMC. The mean LVEF remained unchanged after PTMC. The mean NT-pro-BNP before PTMC was 309.20 ± 17.97 pg/lit that significantly diminished after PTMC to 235.72 ± 22.46 pg/lit (p = 0.009). Among all echocardiography parameters, only MPG was positively associated with the change in NT-pro-BNP after PTMC. Comparing the change in echocardiography indices between the patients with normal rhythm and those with AF, lower change in PAP was shown in the group with AF. However, more change in the level of NT-pro-BNP after PTMC was shown in the patients with AF compared to those without this arrhythmia. Conclusion. PTMC procedure leads to reduce the level of NT-pro-BNP. The change in NT-pro-BNP is an indicator for change in MS severity indicated by decreasing MPG parameter. Lower change in PAP as well as higher change in NT-pro-BNP is predicted following PTMC in the group with AF compared to those with normal sinus rhythm.

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“…Plasma BNP levels have been shown to decrease after PTMC within 24 hours in MS patients in sinus rhythm [27]. Another study from our institution has shown depression of elevated NT-pro BNP levels after successful PTMC in MS patients [28]. It should be noted that our study had a longer follow-up period of 12 weeks unlike the early post-operative blood sampling in previous studies.…”

Section: Discussionmentioning

confidence: 91%

Effect of Percutaneous Transvenous Mitral Commissurotomy on Plasma Apelin Level in Mitral Stenosis Patients

Prabhakar¹

2014

J Clin Exp Cardiolog

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Background: Apelin is an endogenous peptide with positive inotropic property secreted by the heart besides other tissues. Plasma apelin levels are altered in chronic heart failure with left ventricular dysfunction. However, the effect of left atrial hemodynamic overload on plasma apelin levels in mitral stenosis (MS) is unknown. In this observational study, we estimated plasma apelin level in MS patients, before and twelve weeks after percutaneous transvenous mitral commissurotomy (PTMC) and compared with plasma brain natriuretic peptide (BNP) levels, mitral valvular pressure gradient and quality of life measure. Methods: Venous blood samples were drawn from 10 MS patients and 10 age-matched controls, with informed consent. Apelin was estimated by competitive ELISA and BNP using an auto-analyzer. PTMC was done by atrial septal puncture and Inoue balloon. Self-administered Kansas City cardiomyopathy questionnaire (KCCQ) was used to assess quality of life. Variables distributed normally were expressed as mean ± S.D. and others as median (interquartile range) and analyzed using appropriate statistical tests. A p-value<0.05 was considered statistically significant. Results: MS patients belonged to NYHA class II & III, had pulmonary artery hypertension but left ventricular ejection fraction>50%. Plasma apelin was lower [320 (167, 515) vs. 570 (415, 680) pg/ml; p=0.028] and BNP level higher [44 (15, 117) vs. 6 (5, 10) pg/ml; p=0.001] in MS patients compared to controls, respectively. PTMC decreased mitral valvular pressure gradient [6.7 (5.0, 8.7) vs. 20.5 (12.4, 27.2) mm of Hg; p=0.012] and improved KCCQ score (84 ± 7 vs. 54 ± 10%; p<0.001) but did not change plasma apelin and BNP levels [330 (192, 465) and 42 (19, 86) pg/ml, respectively]. Conclusion: Plasma apelin is depressed and BNP level raised in MS patients. Changes in plasma apelin level may occur slower compared to hemodynamic and functional improvement post PTMC.

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N-terminal pro-BNP plasma levels before and after percutaneous transvenous mitral commissurotomy for mitral stenosis

Cited by 9 publications

References 7 publications

Changes in Serum NT-Pro BNP and Left Atrial BNP Levels after Percutaneous Transvenous Mitral Commissurotomy in Sinus Rhythm Versus Atrial Firilation

Changes in Serum NT-Pro BNP and Left Atrial BNP Levels after Percutaneous Transvenous Mitral Commissurotomy in Sinus Rhythm Versus Atrial Firilation

The change in NT-pro-BNP and post-PTMC echocardiography parameters in patients with mitral stenosis. A pilot study

Effect of Percutaneous Transvenous Mitral Commissurotomy on Plasma Apelin Level in Mitral Stenosis Patients

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