The role of natriuretic peptides in patients with chronic complex (mixed or multiple) heart valve disease.
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 VO(2) 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 (beta=-9.3, SE=1.9, P<.0001) and lean body weight (beta=0.59, SE=0.22, P=.01) were dominant independent predictors of peak VO(2). An NT-proBNP value of 84 pmol/L had 77% sensitivity and 70% specificity to predict impaired functional capacity, peak VO(2) <60% (predicted), area under the curve=0.80. Resting NT-proBNP was the best predictor of peak VO(2) in patients with complex valve disease, while symptoms and ejection fraction are a less reliable guide.
Bissessor
Naylin
N
Department of Cardiology, Griffiths University Medical School, Gold Coast Hospital, Gold Coast, Queensland, Australia. naylinbissessor@hotmail.com
Shanahan
Luke
L
Wee
Yong Shen
YS
Stewart
Ralph
R
Lowe
Boris
B
Kerr
Andrew
A
Zeng
Irene
I
Jayasinghe
Rohan
R
White
Harvey
H
D015415:Biomarkers; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging; D006349:Heart Valve Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000378:metabolism; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010101:Oxygen Consumption; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013223:Statistics as Topic; D014463:Ultrasonography
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain