title: The impact of right ventricular stroke work on B-type natriuretic peptide levels in patients with mitral stenosis undergoing percutaneous mitral valvuloplasty.
abstract: OBJECTIVE
  We aimed to explore the relationship between brain natriuretic peptide (BNP) levels and right ventricular (RV) function in patients with mitral stenosis (MS), and to investigate the hemodynamic parameters that predict reduction of BNP levels after percutaneous mitral valvuloplasty (PMV).
  
  
  BACKGROUND
  Few studies have evaluated BNP in the context of MS, specifically the impact of the RV stroke work (RVSW) on serum BNP levels has not been defined.
  
  
  METHODS
  Thirty patients with symptomatic rheumatic MS in sinus rhythm who were referred for a PMV were enrolled. Right and left heart pressures were obtained before and after valvuloplasty. RVSW index (RVSWI) was calculated by cardiac catheterization.
  
  
  RESULTS
  Basal BNP levels were elevated in MS patients and correlated with several hemodynamic parameters including pulmonary pressure, pulmonary vascular resistance index, cardiac index (CI), and RVSWI. In multivariate analysis, CI and RVSWI were independent predictors of raised basal BNP levels. PMV resulted in a significant decrease in the RVSWI with a concurrent increase in CI (2.4 ± 0.43 to 2.9 ± 0.8 L/min/m(2), P = 0.010). Overall, plasma BNP levels significantly decreased from 124 (63/234) to 73 (48/148) pg/ml postvalvuloplasty. Multivariate analysis revealed that the reduction of left atrial (LA) pressure post-PMV was an independent predictor of change in BNP levels.
  
  
  CONCLUSIONS
  Elevated baseline BNP level in MS patients was independently associated with CI and RVSWI. Plasma BNP levels were reduced after successful PMV, which was associated with the reduction of the LA pressure.
authors.affiliation: Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: William A M
authors.initials: WA
authors.lastname: Esteves
authors.forename: Lucas
authors.initials: L
authors.lastname: Lodi-Junqueira
authors.forename: Cirilo P Fonseca
authors.initials: CP
authors.lastname: Neto
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Tan
authors.forename: Bruno R
authors.initials: BR
authors.lastname: Nascimento
authors.forename: Praveen
authors.initials: P
authors.lastname: Mehrotra
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Barbosa
authors.forename: Antonio Luiz P
authors.initials: AL
authors.lastname: Ribeiro
authors.forename: Maria Carmo P
authors.initials: MC
authors.lastname: Nunes
mesh_terms: D000328:Adult; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000097:blood* / Q000503:physiopathology* / Q000601:surgery; D020097:Natriuretic Peptide, Brain / Q000097:blood*
chemical_list: D020097:Natriuretic Peptide, Brain