Relationship between B-type natriuretic peptide levels and echocardiographic indices of left ventricular filling pressures in post-cardiac surgery patients

Abstract

BackgroundB-type natriuretic peptide (BNP) is increased in post-cardiac surgery patients, however the mechanisms underlying BNP release are still unclear. In the current study, we aimed to assess the relationship between postoperative BNP levels and left ventricular filling pressures in post-cardiac surgery patients.MethodsWe prospectively enrolled 134 consecutive patients referred to our Center 8 ± 5 days after cardiac surgery. BNP was sampled at hospital admission and related to the following echocardiographic parameters: left ventricular (LV) diastolic volume (DV), LV systolic volume (SV), LV ejection fraction (EF), LV mass, relative wall thickness (RWT), indexed left atrial volume (iLAV), mitral inflow E/A ratio, mitral E wave deceleration time (DT), ratio of the transmitral E wave to the Doppler tissue early mitral annulus velocity (E/E').ResultsA total of 124 patients had both BNP and echocardiographic data. The BNP values were significantly elevated (mean 353 ± 356 pg/ml), with normal value in only 17 patients (13.7%). Mean LVEF was 59 ± 10% (LVEF ≥50% in 108 pts). There was no relationship between BNP and LVEF (p = 0.11), LVDV (p = 0.88), LVSV (p = 0.50), E/A (p = 0.77), DT (p = 0.33) or RWT (p = 0.50). In contrast, BNP was directly related to E/E' (p < 0.001), LV mass (p = 0.006) and iLAV (p = 0.026). At multivariable regression analysis, age and E/E' were the only independent predictors of BNP levels.ConclusionIn post-cardiac surgery patients with overall preserved LV systolic function, the significant increase in BNP levels is related to E/E', an echocardiographic parameter of elevated LV filling pressures which indicates left atrial pressure as a major determinant in BNP release in this clinical setting.

B-type natriuretic peptide levels predict functional capacity in postcardiac surgery patients

“…Although our population was not selected, this might not represent the whole spectrum of postcardiac surgery patients. We have previously found a relationship between BNP levels and echocardiographic indices of left ventricular filling pressures [9]; however, in the present study, E/E 0 and iLAV failed to be important for predicting functional capacity. This can be explained by the multifactorial determinants of exercise capacity and the complex hemodynamic effects of BNP release after cardiac surgery [16].…”

“…Recent studies indicate that BNP is also increased in patients after cardiac surgery [8,9]. Thus, we hypothesized that BNP could play a major role in determining the functional disability of postcardiac surgery patients.…”

Benefits of Cardiac Rehabilitation in Heart Failure Patients According to Etiology

“…Inversely, BNP remained higher in C patients in agreement with the relationship observed between plasma BNP levels and the left ventricular systolic function. 38 , 39 BNP concentrations measured in plasma of coronary patients remained significantly higher than those of NC patients. BNP concentrations of C patients were <400 pg/mL and remained in the range measured in similar patients.…”

Parallel improvement of left ventricular geometry and filling pressure after transcatheter aortic valve implantation in high risk aortic stenosis: comparison with major prosthetic surgery by standard echo Doppler evaluation

“…This relation remained significant even after adjusting for age and percent reduction of Zva, an index of LV global load which accounts for the effects of both AS and systemic arterial compliance, is one of the main determinant of exercise capacity [44] and is prognostically validated [42]. In post-cardiac surgery of patients with overall preserved systolic LV chamber function, the degree of E/e’ ratio had been shown to be significantly associated with BNP levels, a finding which indicates left atrial pressure as a major determinant in BNP release in this clinical setting [45]. The results of the present study highlight therefore how the early recovery of LV geometry occurring after TAVI could be as fast as a beneficial effect on the reduction of LV filling pressure and may well explain the evidence of better short and long-term prognosis of patients with AS undergoing TAVI [18-22].…”