title: Change of B-type natriuretic peptide after surgery and its association with rhythm status in patients with chronic severe mitral regurgitation.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) is a useful biomarker of cardiac function in patients with mitral regurgitation (MR). However, the change in BNP in association with rhythm status after corrective surgery has not been studied.
  
  
  METHODS
  A total of 101 patients with chronic severe MR undergoing surgery were prospectively enrolled. BNP assays and echocardiographic studies were conducted before and 6 months after surgery. Patients were divided into 3 groups according to pre- and postoperative rhythm (sinus to sinus [SS], n = 61; atrial fibrillation [AF] to sinus [AS], n = 28; AF to AF [AA], n = 12).
  
  
  RESULTS
  BNP decreased only in the AS group 6 months after mitral surgery (from 218.0 ± 136.5 to 94.7 ± 85.1 pg/mL; P < 0.001) but not in the SS or AA groups (P for interaction = 0.001). However, changes of echocardiographic parameters after surgery were not different among the 3 groups. In the AA group, postoperative left ventricular (LV) end-diastolic dimension and left atrial volume were higher than the other groups. Significant determinants of BNP were the presence of AF and the higher pulmonary artery systolic pressure preoperatively (β = 0.767 and P = 0.001 for AF; β = 0.022 and P = 0.019 for pulmonary artery systolic pressure), and the lower LV ejection fraction postoperatively (β = -0.030; P = 0.011).
  
  
  CONCLUSIONS
  After surgical correction of chronic organic severe MR, BNP decreased only in patients with preoperative AF which was converted to sinus rhythm postoperatively. A reduction in BNP was not observed when rhythm status did not change. BNP activation was associated with the presence of AF and LV systolic dysfunction, suggesting its prognostic value.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: In-Chang
authors.initials: IC
authors.lastname: Hwang
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Kim
authors.forename: Seung-Pyo
authors.initials: SP
authors.lastname: Lee
authors.forename: Hyung-Kwan
authors.initials: HK
authors.lastname: Kim
authors.forename: Dae-Won
authors.initials: DW
authors.lastname: Sohn
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Oh
authors.forename: Young-Bae
authors.initials: YB
authors.lastname: Park
mesh_terms: D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain