The Role of Natriuretic Peptides in Patients With Chronic Complex (Mixed or Multiple) Heart Valve Disease

Abstract

N‐terminal prohormone B‐type natriuretic peptide (NT‐proBNP) is an important biomarker of prognosis in heart failure and single valve disease. There are limited studies of complex valve disease. Patients with complex valve disease adopt a sedentary lifestyle, so symptoms may be difficult to detect. The authors aimed to determine whether NT‐proBNP correlates with the severity of the valve lesion and underlying cardiac function and whether resting NT‐proBNP predicts impaired peak VO2 in patients with complex valve disease. Forty‐five patients with complex moderate to severe stenosis or regurgitation of the heart valves underwent a clinical assessment, echocardiography, resting NT‐proBNP assessment, and formal cardiopulmonary exercise testing. In a multivariate analysis, the log NT‐proBNP (β=−9.3, SE=1.9, P<.0001) and lean body weight (β=0.59, SE=0.22, P=.01) were dominant independent predictors of peak VO2. An NT‐proBNP value of 84 pmol/L had 77% sensitivity and 70% specificity to predict impaired functional capacity, peak VO2 <60% (predicted), area under the curve=0.80. Resting NT‐proBNP was the best predictor of peak VO2 in patients with complex valve disease, while symptoms and ejection fraction are a less reliable guide. Congest Heart Fail. 2010;16:50–54. © 2009 Wiley Periodicals, Inc.

Non-Invasive Assessment of Multivalvular Heart Disease: A Comprehensive Review

“…In patients with heart failure, brain natriuretic peptide (BNP) levels predict exercise performance and prognosis and, in patients with single valve disease, an increase of BNP levels has been shown to correlate with the severity of valve lesion and LV dimensions [ 71 , 72 ]. NT-proBNP level was demonstrated to be a dominant predictor of peak oxygen consumption at the cardiopulmonary exercise testing, while traditional markers of valve disease severity as ejection fraction, fractional shortening, and diastolic dysfunction were only moderately correlated with the exercise capacity [ 73 ]. Even though cutoffs are lacking, these results suggest that in the setting of moderate to severe MVD additional information on functional capacity and hemodynamic effect can be provided by the serial testing of natriuretic peptides, especially in the asymptomatic or vaguely symptomatic patients, on top of clinical evaluation and echocardiography.…”

Assessment of Complex Multi-Valve Disease and Prosthetic Valves

“…The early management of less-thansevere MVD, before the onset of symptoms and irreversible LV/ RV dysfunction is probably the key for improving prognosis. In this setting, the exercise-induced increase in transvalvular gradients and pulmonary artery pressure along with the N-terminal pro B-type natriuretic peptide (NT-pro BNP) estimations may be helpful in predicting outcomes and in determining the optimal timing for intervention [18,61].…”

Pathophysiology and management of multivalvular disease

“…The consequences of the overall haemodynamic burden on the cardiac chambers, pulmonary circulation, and patient’s functional capacity should be assessed. Therefore, maximal exercise capacity and peak oxygen consumption, parameters of ventricular function (such as LV global longitudinal strain, RV tricuspid annulus plane excursion, or free-wall strain), as well as natriuretic peptide levels and pulmonary arterial pressure at rest and during exercise should be measured 100, 101 . Surgery might be appropriate for selected patients in whom the combination of moderate lesions has a meaningful effect on the functional parameters mentioned above.…”