B-type Natriuretic Peptide as an Index of Symptoms and Severity of Chronic Rheumatic Mitral Regurgitation.
BACKGROUND
The most common causes of severe mitral regurgitation (MR) in developing countries are rheumatic heart disease. The plasma level of B-type natriuretic peptide (BNP) is known to increase with left ventricular (LV) dysfunction.


OBJECTIVE
To study BNP level as an index of symptoms and severity of chronic rheumatic MR.


METHODS
One hundred and forty patients with rheumatic MR and LV ejection fractions (EFs) of >55% underwent assessment of symptoms, transthoracic echocardiography, and measurement of BNP.


RESULTS
The level of BNP rose with increasing left atrium (LA) dimensions and volumes, LV dimensions and volumes, echocardiographic parameters of MR severity (width of the vena contracta, regurgitation jet area, effective regurgitation orifice area, and regurgitant volume), and E waves.


RESULTS
BNP was significantly higher in patients with severe MR compared with moderate and mild MR (P < 0.001), and using cutoff point of 61 pg/mL mm had 97% sensitivity and 89% specificity for predicting patients with severe MR (0.99, 95% confidence interval [CI] 0.9-1). BNP was significantly higher in patients with New York Heart Association (NYHA III) compared with NYHA II, I and asymptomatic patients (P < 0.001) and using cutoff point of 53 pg/mL had 97% sensitivity and 87% specificity for predicting symptomatic patients with symptomatic MR (0.81, 95% CI 0.70-0.92).


CONCLUSIONS
BNP level increase with increasing severity of rheumatic MR and are higher in symptomatic compared to asymptomatic patients, even in the presence of normal EF%.
Department of Cardiology, Fayoum University, Egypt.
Eman M
EM
Abdel Fattah
Department of Cardiology, Fayoum University, Egypt.
Hany Younan Azer
HY
Girgis
Department of Cardiology, Fayoum University, Egypt.
Khaled
K
El Khashab
Department of Cardiology, Cairo University, Egypt.
Zeinab A
ZA
Ashour
Department of Clinical Pathology, Fayoum University, Egypt.
Ghada M
GM
Ezzat
B-type natriuretic peptide; mitral regurgitation; rheumatic heart