Determinants of the reduction in B-type natriuretic peptide after mitral valve replacement in patients with rheumatic mitral stenosis.
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.
Leszek
Przemyslaw
P
Institute of Cardiology, Warsaw, Poland. przemyslaw.leszek@ikard.pl
Klisiewicz
Anna
A
Janas
Jadwiga
J
Różański
Jacek
J
Rywik
Tomasz
T
Piotrowski
Walerian
W
Korewicki
Jerzy
J
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
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain