title: Determinants of the reduction in B-type natriuretic peptide after mitral valve replacement in patients with rheumatic mitral stenosis.
abstract: BACKGROUND
  Plasma B-type natriuretic peptide (BNP) levels are closely related to symptoms in left ventricle (LV) systolic heart failure, although marked regarding heterogeneity levels among subjects are reported.
  
  
  OBJECTIVE
  To assess the influence of right ventricle on plasma BNP in the patients with different grades of its overload secondary to severe mitral valve stenosis (MVS).
  
  
  METHODS
  Plasma BNP was evaluated in MVS patients (n = 27) before valve replacement and during follow-up (FUV) 401 ± 42 days after operation.
  
  
  RESULTS
  Initial examination showed severe MVS (0.9 ± 0.2 cm²), left atrial enlargement (LAI 30 ± 4.5 mm m⁻²), right ventricle diastolic dilatation (RVDI 16 ± 3.6 mm m⁻²), normal LV size/function and elevated BNP levels (166 ± 137 pg ml⁻¹). FUV examination revealed a significant reduction in LAI (27 ± 2.2 mm m⁻²), RVDI (14 ± 1.6 mm m⁻²) and BNP levels (80 ± 35 pg ml⁻¹). The regression analysis of the initial parameters found RVDI to be the strongest predictor (R² = 0.61; P<0.0001) for BNP level, whereas RVDI reduction was the strongest factor for BNP decrease (R² = 0.65; P<0.0001) during FUV.
  
  
  CONCLUSIONS
  Right ventricle should be taken into account as a potential important source of plasma BNP owing to the fact that LV size and function are well preserved in MVS patients. RVDI determines BNP plasma levels whereas after MVS removal, the RVDI reduction predicts BNP level decrease.
authors.affiliation: Institute of Cardiology, Warsaw, Poland. przemyslaw.leszek@ikard.pl
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Leszek
authors.forename: Anna
authors.initials: A
authors.lastname: Klisiewicz
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Janas
authors.forename: Jacek
authors.initials: J
authors.lastname: Różański
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rywik
authors.forename: Walerian
authors.initials: W
authors.lastname: Piotrowski
authors.forename: Jerzy
authors.initials: J
authors.lastname: Korewicki
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015536:Down-Regulation; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000378:metabolism; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011044:Poland; D012044:Regression Analysis; D012214:Rheumatic Heart Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain