B-type natriuretic Peptide in isolated severe tricuspid regurgitation: determinants and impact on outcome.
BACKGROUND
The plasma B-type natriuretic peptide (BNP) level is a useful prognostic marker in heart failure and valvular heart disease. In patients with isolated severe tricuspid regurgitation (TR), little is known about the determinants of plasma BNP levels and the correlation with future outcome. The purpose of this study was to identify the determinants of plasma BNP levels in patients with isolated severe TR and the value of the BNP level in predicting postoperative outcomes after corrective surgery.


METHODS
We prospectively enrolled 39 patients with isolated, severe TR undergoing corrective surgery. A plasma BNP assay and cardiac magnetic resonance (CMR) imaging were performed before surgery. The combined end-point was the occurrence of cardiac death or readmission due to heart failure.


RESULTS
Linear regression analysis showed that the left ventricular ejection fraction and right ventricular end systolic volume were the most important determinants of the BNP levels (p = 0.002, R(2) = 0.315). Based on the receiver operating characteristics (ROC) curve, we were able to derive an optimal cutoff value (200 pg/mL) to predict postoperative cardiac death with a sensitivity of 80% and a specificity of 85%. The one-year survival rate was 96% in patients with a BNP < 200 pg/mL and 53% in patients with a BNP ≥ 200 pg/dL (p = 0.001).


CONCLUSIONS
An elevation in the BNP level is determined by the functional status of the right and left ventricles in patients with isolated, severe TR. An elevated BNP predicts adverse events after corrective surgery. Therefore, the BNP level should be included in the clinical evaluation and risk stratification of patients with isolated TR.
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Chang-Hwan
CH
Yoon
Joo-Hee
JH
Zo
Yong-Jin
YJ
Kim
Hyung-Kwan
HK
Kim
Dong-Ho
DH
Shine
Kyung-Hwan
KH
Kim
Ki-Bong
KB
Kim
Hyuk
H
Ahn
Dae-Won
DW
Sohn
Byung-Hee
BH
Oh
Young-Bae
YB
Park
J Thorac Cardiovasc Surg. 1989 Jul;98(1):101-10; discussion 110-1
2739416
Am Heart J. 2004 Feb;147(2):218-23
14760316
Br Heart J. 1991 Oct;66(4):295-301
1747281
Eur Heart J. 2010 Jun;31(12):1520-8
20233787
Circulation. 2005 Aug 30;112(9 Suppl):I14-9
16159806
J Cardiovasc Pharmacol. 1998 Jan;31(1):116-25
9456286
J Heart Valve Dis. 1999 Sep;8(5):567-74
10517400
Circulation. 2009 Oct 27;120(17):1672-8
19822809
Clin Exp Pharmacol Physiol Suppl. 1995 Dec;22(1):S186-7
9072348
Chem Pharm Bull (Tokyo). 1997 Feb;45(2):402-5
9118454
Arch Cardiovasc Dis. 2008 May;101(5):295-7
18656086
J Clin Invest. 1991 Apr;87(4):1402-12
1849149
Am J Cardiol. 2006 Jul 15;98(2):236-42
16828600
Eur J Cardiothorac Surg. 2001 Sep;20(3):577-82
11509282
J Am Coll Cardiol. 2004 Feb 4;43(3):405-9
15013122
Circulation. 2005 May 10;111(18):2391-7
15883225
Am J Cardiol. 2006 Sep 1;98(5):659-61
16923456
Clin Physiol Funct Imaging. 2009 Jul;29(4):229-40
19302226
Eur J Heart Fail. 2007 Sep;9(9):892-6
17613272
J Am Coll Cardiol. 2009 Sep 15;54(12):1099-106
19744620