title: Ratio of preoperative atrial natriuretic peptide to brain natriuretic peptide predicts the outcome of the maze procedure in mitral valve disease.
abstract: BACKGROUND
  Although the maze procedure is an established surgical treatment for eliminating atrial fibrillation (AF), its efficacy in patients with mitral valve disease has remained unsatisfactory. A useful predictive marker for the outcome of the maze procedure is needed. The aim of this study was to investigate whether the preoperative ratio of atrial natriuretic peptide (ANP) to brain natriuretic peptide (BNP) reflects atrial fibrosis and can be used to predict the maze procedure outcome in patients with mitral valve disease.
  
  
  METHODS
  A total of 23 consecutive patients who underwent the radial approach to the maze procedure combined with mitral valve surgery were included in this study and were divided into a sinus rhythm (SR) group (n=16) and an AF group (n=7) based on postoperative cardiac rhythm. Plasma samples were obtained at rest before the operation and were analysed for ANP and BNP levels. Atrial tissue samples taken during surgery were used to quantify interstitial fibrosis.
  
  
  RESULTS
  The preoperative ANP-to-BNP ratio in the SR group was significantly higher than that in the AF group (0.74 +/- 0.29 vs. 0.42 +/- 0.28, respectively; p=0.025). Receiver operating characteristic (ROC) curve analysis was used to identify factors that predict outcomes after the maze procedure. The area under the ROC curve for the ANP-to-BNP ratio (0.81) was greater than for any other preoperative factors. Moreover, the preoperative ANP-to-BNP ratio demonstrated a negative correlation with left atrial fibrosis (r=-0.69; p=0.003).
  
  
  CONCLUSIONS
  The preoperative ANP-to-BNP ratio can predict maze procedure outcome in patients with mitral valve disease, and it represents a potential biomarker for left atrial fibrosis.
authors: Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
authors: Masafumi
authors: M
authors: Sato
authors: Akihito
authors: A
authors: Mikamo
authors: Hiroshi
authors: H
authors: Kurazumi
authors: Ryo
authors: R
authors: Suzuki
authors: Masanori
authors: M
authors: Murakami
authors: Toshiro
authors: T
authors: Kobayashi
authors: Koich
authors: K
authors: Yoshimura
authors: Kimikazu
authors: K
authors: Hamano
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation; D009320:Atrial Natriuretic Factor / Q000097:blood*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D005355:Fibrosis / Q000378:metabolism; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000097:blood* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012372:ROC Curve; D016896:Treatment Outcome
chemical_list: D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor