The effect of aortic valve replacement on N‐terminal natriuretic propeptides in patients with aortic stenosis

Qi, Wei; Mathisen, Per; Kjekshus, John; Simonsen, Svein; Endresen, Knut; Bjørnerheim, Reidar; Hall, Christian

doi:10.1002/clc.4960250408

Cited by 25 publications

(12 citation statements)

References 20 publications

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“…Previously, ANP levels have been evaluated in AS patients and found to mirror symptom onset [15]. In addition, temporal changes in ANP values have been evaluated separately [6]. In our study, N-ANP levels were significantly higher in AS patients than in the controls, and they decreased significantly following surgery, in accordance with previous reports.…”

Section: Discussionsupporting

confidence: 82%

“…Although it has previously been shown that the plasma NP level is related to disease severity in AS, with decreased levels following surgery [6], the association between arrhythmogenic complications following surgery for AS and NP has not been studied yet. Increased atrial NP (ANP) levels before and after surgery concomitant with temporal changes in echocardiographic findings might help to elucidate the pathophysiology of AF and the increased morbidity associated with AF after surgery.…”

Section: Introductionmentioning

confidence: 99%

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Atrial Natriuretic Peptide Predicts Impaired Atrial Remodeling and Occurrence of Late Postoperative Atrial Fibrillation after Surgery for Symptomatic Aortic Stenosis

Yilmaz

Erbay²,

Balcı³

et al. 2006

Cardiology

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Background: Aortic stenosis (AS) and atrial fibrillation (AF) are commonly encountered in clinical practice. Natriuretic peptides (NP) are endogenous cardiac hormones, which have been shown to increase in patients with heart failure, and valvular or congenital heart disease. We aimed to determine the association between atrial NP (ANP) and late postoperative AF after surgery for AS along with temporal changes in plasma ANP levels and left atrial (LA) volumes. Methods: 22 patients (16 males/6 females, mean age: 61 years) with symptomatic AS and 8 healthy volunteers (5 males/3 females) were enrolled into our study. All the patients studied underwent transthoracic echocardiography, which was repeated during the follow-up. N-terminal ANP (N-ANP) was studied initially and at the 2-month follow-up. Postoperatively, the patients were followed up for 12 months for AF attacks. Results: Patients with AS had significantly higher levels of N-ANP, left ventricular (LV) end-diastolic pressure, E/A ratio, LV mass and LA volumes compared to the controls. Patients with postoperative AF attacks were significantly older, had higher N-ANP levels and LV end-diastolic pressure in addition to higher LA volumes and longer symptom duration compared to patients without AF. Age at the time of operation (p = 0.011) and N-ANP at the 2nd month (p = 0.047) were found to be independent predictors for late AF attacks during follow-up in regression analysis. Besides, N-ANP (p < 0.001) at the 2-month follow-up independently predicted impaired LA remodeling. Conclusion: ANP might be an important factor to identify AS patients at risk for late postoperative AF attacks.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Atrial Natriuretic Peptide Predicts Impaired Atrial Remodeling and Occurrence of Late Postoperative Atrial Fibrillation after Surgery for Symptomatic Aortic Stenosis

Yilmaz

Erbay²,

Balcı³

et al. 2006

Cardiology

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“…The BNP level reflects the severity of heart failure, is associated with LV structure and function in severe AS as well as is an independent predictor of complication and outcome after AVR [10][11][12][13][14][15]. Moreover, it is strongly related to the development of symptom onset and increases progressively with worsening postoperative New York Heart Association (NYHA) functional class [11].…”

Section: Introductionmentioning

confidence: 99%

B-type natriuretic peptide as a biochemical marker of left ventricular diastolic function: assessment in asymptomatic patients 1 year after valve replacement for aortic stenosis

Mannacio

Antignano

Amicis

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES: Left ventricular (LV) diastolic dysfunction after aortic valve replacement (AVR) carries a substantial risk of development of heart failure and reduced survival. In addition to echocardiography, B-type natriuretic peptide (BNP) provides a powerful incremental assessment of diastolic function. This study evaluates BNP as a marker of LV diastolic dysfunction in a cohort of patients with preserved LV ejection fraction who underwent AVR for pure aortic stenosis and the relationship between BNP values and the grade of LV diastolic dysfunction. METHODS:A total of 113 patients were included in the study. Echocardiographic evaluation was performed preoperatively, 5 days postoperatively and at 12-month follow-up, to assess LV dimensional and functional parameters. Diastolic function was labelled as normal, mild, moderate or severe dysfunction. Concomitantly, BNP levels were evaluated. RESULTS:Mild to severe diastolic dysfunction occurred preoperatively in all patients. At 12-month follow-up, 65 (62.5%) patients had mild and 25 (24.1%) moderate to severe diastolic dysfunction. BNP values, categorized for quartile distribution, correlated with diastolic dysfunction grade (P < 0.001 for each comparison). At receiver operating characteristic analysis, the BNP level of 120 pg/ml was 91% sensitive and 85% specific for diastolic disease, while 300 pg/ml was 80% sensitive and 91% specific for moderate or severe diastolic dysfunction. Twelve months after AVR, BNP values were strongly correlated with the significant echocardiographic parameters suggestive of diastolic dysfunction (P ≤ 0.006 in all cases). CONCLUSIONS:The BNP level following AVR is related to diastolic disease severity and may complement echocardiographic evaluation when symptoms are unclear and LV function is difficult to interpret.

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“…The circulating levels of these peptides are known to be elevated in response to increased cardiac wall stress and myocardial hypertrophy in states of pressure and/or volume overload [5,6,7,8]. Chronic aortic regurgitation (AR) or aortic stenosis (AS) is known to be associated with increased volume and/or pressure overload of the left ventricle (LV) leading to myocardial hypertrophy with LV dilatation and failure [9,10,11,12]. However, little data are currently available regarding the relationship between NT-proBNP levels and clinical characteristics, LV function or LV mass index (LVMI) in patients with chronic severe aortic valve diseases [13,14].…”

Section: Introductionmentioning

confidence: 99%

Preoperative, Postoperative and One-Year Follow-Up of N-Terminal Pro-B-Type Natriuretic Peptide Levels in Volume Overload of Aortic Regurgitation: Comparison with Pressure Overload of Aortic Stenosis

et al. 2010

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Objectives: Limited data are available regarding the impact of pressure or volume overload on the clinical or echocardiographic parameters and the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with chronic severe aortic valve diseases. We aimed to investigate and compare the relationships between these parameters in such patients. Methods: One hundred twenty-four consecutive patients who underwent aortic valve replacement for chronic severe aortic valve diseases were enrolled. Plasma NT- proBNP was measured and echocardiographic parameters were recorded before surgery, before discharge and 12 months after surgery. Results: NT-proBNP levels were significantly higher in patients with aortic regurgitation (AR) (n = 63) than in those with aortic stenosis (n = 61) (1,836.0 ± 376.1 vs. 508.4 ± 74.5 pg/ml, p = 0.001). There was a significant relationship between NT-proBNP levels and left ventricular mass index (LVMI) in AR (r = 0.436, p = 0.002) and a weaker, but significant, relationship between NT-proBNP levels and LVMI in aortic stenosis patients (r = 0.290, p = 0.046). In the AR group, preoperative NT-proBNP levels positively correlated with LVMI regression during the 12 months after surgery (r = 0.488, p = 0.001). Conclusion: NT-proBNP levels may reflect LVMI changes that are caused by volume overload rather than pressure overload in chronic aortic valve diseases. Higher preoperative NT-proBNP levels may predict left ventricular reverse remodeling early after surgery for chronic severe AR.

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The effect of aortic valve replacement on N‐terminal natriuretic propeptides in patients with aortic stenosis

Cited by 25 publications

References 20 publications

Atrial Natriuretic Peptide Predicts Impaired Atrial Remodeling and Occurrence of Late Postoperative Atrial Fibrillation after Surgery for Symptomatic Aortic Stenosis

Atrial Natriuretic Peptide Predicts Impaired Atrial Remodeling and Occurrence of Late Postoperative Atrial Fibrillation after Surgery for Symptomatic Aortic Stenosis

B-type natriuretic peptide as a biochemical marker of left ventricular diastolic function: assessment in asymptomatic patients 1 year after valve replacement for aortic stenosis

Preoperative, Postoperative and One-Year Follow-Up of N-Terminal Pro-B-Type Natriuretic Peptide Levels in Volume Overload of Aortic Regurgitation: Comparison with Pressure Overload of Aortic Stenosis

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