title: Is measurement of plasma brain natriuretic peptide levels a useful test to detect for surgical timing of valve disease?
abstract: BACKGROUND
  The optimal timing of valve surgery is very important. In patients who are severely symptomatic, the marked improvement in symptomatic status observed following successful valve surgery. However, in patients with no or only mild symptoms, the decision is more difficult. The aim of this retrospective study was to determine whether the measurement of plasma brain natriuretic peptides (BNP) levels is useful to decide surgical timing for valve disease.
  
  
  METHODS
  Fifty-one patients with valve disease underwent single valve surgery (mitral stenosis, MS, 13; mitral regurgitation, MR, 16; aortic stenosis, AS, 14; aortic regurgitation, AR, 8 patients). Blood samples, echocardiographic and cardiac catheterization data were obtained before operation and echocardiographic examination were performed after 1-year of operations.
  
  
  RESULTS
  In patients subjected to single heart valve surgery, plasma BNP mean levels were 214.6+/-48.5 pg/ml. In plasma BNP levels, there was only significant difference between MS and AS group (MS 67.5+/-9.7 vs. AS 314.3+/-112.0 pg/ml, P=0.04). There were no relationships between plasma BNP levels and pre-operative cardiac functions. After 1-year of the valve surgery, NYHA functional class was reduced in 36 patients (70.6%) and plasma BNP levels before the surgery significantly correlated with post-operative NYHA functional class.
  
  
  CONCLUSIONS
  In this retrospective study, patients with high plasma BNP levels significantly impaired the improvement of clinical symptoms after surgery. We have suggested that plasma BNP levels is useful for detecting asymptomatic valvular disease, and is a clinical marker useful in determining the optimal surgical timing.
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Metropolitan Hiroo General Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo 150-0013, Japan. masa-cvs@hiroo-hospital.metro.tokyo.jp
authors.forename: Masazumi
authors.initials: M
authors.lastname: Watanabe
authors.forename: Mikiko
authors.initials: M
authors.lastname: Murakami
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Furukawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakahara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain